Insurance Group Information | Medicare Billing: CMS-1450 & 837I

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

Loop 2330B/FL 61 A-C

If the patient has an employer group health plan, enter the group name. Lines B and C are required when other insurance, payers, or health plans are involved in paying the claim and when FLs 62 B and C, which are used to report group numbers for secondary and tertiary payers, aren't used.

Table 24: Loop 2330B/FL 61 A-C Fields
Insurance Group Name for Primary, Secondary, and Tertiary	Source
Enter the name of the group or plan that delivers the health insurance coverage to the insured.	Patient or provider records

When providers claim payment under the circumstances described in FLs 58 A, B, or C and a WC or an EGHP, enter the name of the group or plan offering that insurance. Otherwise, leave this field blank.

Loop 2330B/FL 62 A-C

If the patient has an employer group health plan, enter the group number. Lines B and C are required when other insurance, payers, or health plans are involved in paying the claim and when FLs 62 B and C aren’t used.

Table 25: Loop 2330B/FL 62 A-C Fields
Insurance Group No. for Primary, Secondary, and Tertiary	Source
When providers claim payment under circumstances described in FLs 58A, B, or C and a WC or an EGHP, enter the identification number, control number, or code assigned by that health insurance carrier to identify the group covering the insured person.	Patient or provider records