Reporting Primary Insurance Information
The following slides will show you how to report insurance details on claims.
Loop 2330A NM1 / Item 4
| Insured’s Name | Source |
|---|---|
If there’s insurance primary to Medicare, either through the patient’s or spouse’s employment or any other source, list the name of the insured here. When the insured and the patient are the same, enter the word Same in item 4. If Medicare is primary, leave blank. To report insurance primary to Medicare on the 837P, use Loops 2320-2330G. To report the Primary Payer Subscriber information, use 2330A. | Patient’s insurance card |
Loop 2320 SBR02 / Item 6
| Patient’s Relationship to Insured | Source |
|---|---|
Check the correct box for the patient’s relationship to the insured when you complete item 4 Insured’s Name. For the 837P, enter the Patient Relationship to the Insured in Loop 2320 SBR02. | Patient records |
Loop 2300 CLM11 / Items 10A-10C
| Is Patient’s Condition Related to? | Source |
|---|---|
Check Yes or No to show whether employment, auto liability, or other accident involvement applies to 1 or more of the services described in item 24D Procedures, Services, or Supplies. Enter the state postal code. Any item checked Yes indicates possible other insurance primary to Medicare. Name primary insurance information in item 11 Insured’s Policy Group or FECA Number. For the 837P, enter the Related Causes Code in Loop 2300 CLM11. | Patient records |
Loop 2010BA DMG / Item 11a
| Insured’s Date of Birth & Sex | Source |
|---|---|
| Enter the insured’s 8-digit birth date (MMDDCCYY) and sex if different from item 3 Patient’s Birth Date and Sex. | Patient records |
Not Mapped / 11b
| Other Claim ID (Designated by NUCC) | Source |
|---|---|
Enter employer’s name, if applicable. If there’s a change in the insured’s insurance status because of retirement, enter either a 6-digit (MMDDYY) or 8-digit (MMDDCCYY) retirement date with the word Retired before it. Enter this information to the right of the vertical dotted line. | Patient records |
Note: Insured's Employer Name or School Name doesn't exist in 837P.