Patient Information

These slides cover how to complete the patient information portion of the CMS-1450 and 837I.

The information we'll cover includes the patient’s name, address, identification numbers, and employment information.

Patient Fields

Patient Control Number
Medical or Health Record Number
Patient Name and ID
Patient Address
Patient Birthdate
Patient Sex
Insured's Name for Primary, Secondary, and Tertiary
Patient's Relationship to Insured for Primary, Secondary, and Tertiary
Insured's Unique ID for Primary, Secondary, and Tertiary - Certificate/SSN/MBI
Employer Name of the Insured for Primary, Secondary, and Tertiary

Loop 2300 CLM01/FL 3a

Table 11: Loop 2300 CLM01/FL 3a Field
Patient Control Number	Source
This field includes the patient’s unique control number the provider assigned them. The patient control number is any alpha-numeric combination chosen by the provider.	Patient or provider records

Providers use the patient control number to help retrieve patients’ financial records and to post payments. The format of the number allows up to 24 characters for paper claim submitters and 20 characters for 837I submitters.

Loop 2300 REF/FL 3b

If the provider assigned a health record number to the patient’s record, report that number in FL 3b.

Table 12: Loop 2300 REF/FL 3b Field
Medical or Health Record Number	Source
Report the number the provider gave the patient’s medical or health record, not FL 3a.	Patient or provider records

Note: FL 3a identifies the patient’s financial record. FL 3b identifies the medical record.

Loop 2010BA, 2010CA/FL 8a and 8b

Table 13: Loop 2010BA, 2010CA/FL 8a and 8b Fields
Patient Name and ID	Source
Enter the patient’s last name, first name, and, if any, middle initial, along with patient identifier, if different from the subscriber or insured’s identifier.	Patient or Medicare records

Loop 2010BA, 2010CA/FL 9a-e

Table 14: Loop 2010BA, 2010CA/FL 9a-e Fields
Patient Address	Source
Enter the patient’s address - street, city, state, ZIP code, P.O. Box, or rural route address.	Patient or provider records

This field allows a 5-digit ZIP Code. FL 9a-e allows a street address or P.O. Box. Some payers may require a country code, but Medicare only requires it for addresses outside the U.S.

Loop 2010BA, 2010CA/FL 10

Table 15: Loop 2010BA, 2010CA/FL 10 Field
Patient Birthdate	Source
Enter the month, day, and year of birth (MMDDCCYY) of the patient.	Patient or Medicare records

MM = 2-digit month
DD = 2-digit day
CCYY = 4-digit year

If the full birthdate is unknown, enter zeros for all 8 digits.

Loop 2010BA, 2010CA/FL 11

Table 16: Loop 2010BA, 2010CA/FL 11 Field
Patient Sex	Source
Enter the patient's sex: M (male) or F (female).	Patient or Medicare records

Record the patient’s sex at admission, outpatient service, or start of care.