Payer Information

These slides cover how to complete the payer information portion on the CMS-1450 and 837I forms.

Next, we’ll discuss completing payer information on the CMS-1450 and 837I. This includes the payer identification, supplemental payers, and payers primary to Medicare.

Payer Fields

Payer Identification
Release of Information for Primary, Secondary, and Tertiary
Prior Payments for Primary, Secondary, and Tertiary
Insurance Group Name for Primary, Secondary, and Tertiary
Insurance Group No. for Primary, Secondary, and Tertiary
Treatment Authorization Code for Primary, Secondary, and Tertiary

Loop 2330B/FL 50 A-C

R: Medicare requires FL 50 A.
S: FLs 50 B and 50 C are situational and only used if the patient has a secondary or tertiary payer.

Table 21: Loop 2330B/FL 50 A-C Fields
Payer Identification	Source
Enter the name of the payer or insurance company.	Patient or provider records

If Medicare is the primary payer, enter Medicare on line A to show that the provider has checked for other insurance and found that Medicare is the primary payer. All other entries across line A — FLs 51-55 — supply information needed by the payer named in FL 50 A. If Medicare is the secondary or tertiary payer, identify the primary payer on line A and enter Medicare information on line B or C.