Key Patient & Claim Information

Now, you’ll learn how to enter patient names, birth dates, addresses, and other critical details.

Loop 2010BA NM1 / Item 2

Table 13: Loop 2010BA NM1 / Item 2 Fields
Patient’s Name	Source
Enter the patient’s last name, first name, and middle initial, if any, as shown on the patient’s insurance card.	Patient’s insurance card

Make sure you report the patient’s name and Medicare number exactly as they appear on the patient’s Medicare card. A MAC will return claims as unprocessable if the patient’s name doesn’t match the Medicare number associated with them in the Medicare files.

When billing on paper, report the name exactly as shown on the Medicare card. Include a suffix, like Jr., Sr., II, or III, only if it’s on the Medicare card. When billing electronic claims, report the patient suffix in the 2010BA NM107 Loop and segment.

Loop 2010BA DMG02 / Item 3

Table 14: Loop 2010BA DMG02 / Item 3 Fields
Patient’s Birth Date & Sex	Source
Enter the patient’s 8-digit birth date (MMDDCCYY). Enter the patient's sex: M (male) or F (female).	Patient records

Loop 2010BA N3 & N4 / Item 5

Table 15: Loop 2010BA N3 & N4 / Item 5 Fields
Patient’s Address & Telephone Number	Source
Enter the patient’s mailing address and telephone number. On the first line, enter the street address On the second line, enter the city and state On the third line, enter the ZIP Code and phone number For the 837P, you don’t submit the phone number in 2010BA PER.	Patient records

Loop 2300 CLM09 / Item 12

Table 16: Loop 2300 CLM09 / Item 12 Fields
Patient’s or Authorized Person’s Signature	Source
When completing the CMS-1500, the patient or authorized representative must sign and enter a 6-digit date (MMDDYY), an 8-digit date (MMDDCCYY), or an alpha-numeric date like January 1, 2025, unless the signature is on file. When completing the 837P, you must use the appropriate Release of Information code.	Patient records

Resource

Medicare Claims Processing Manual, Chapter 26

The patient’s signature authorizes release of medical information for claim processing and allows payment of benefits to the provider of service or supplier who accepts assignment on the claim.

Loop 2300 DTP / Item 14

Table 17: Loop 2300 DTP / Item 14 Fields
Date of Current Illness, Injury, or Pregnancy (LMP)	Source
When completing the CMS-1500, enter either an 8-digit (MMDDCCYY) or a 6-digit (MMDDYY) date of current illness, injury, or pregnancy. For chiropractic services, enter an 8-digit (MMDDCCYY) or a 6-digit (MMDDYY) date of the initiation of the course of treatment and enter an 8-digit (MMDDCCYY) or a 6-digit (MMDDYY) date in item 19. When completing the 837P, use the 2300 DTP Onset of Current Illness or Symptom to report date of current illness or injury. Use the 2300 DTP Last Menstrual Period for reporting pregnancy.	Patient records