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Medicare Billing: 837P & Form CMS-1500

Loop 2330A NM1/Item 9

situationally required icon

Patients may assign their rights to payment to the provider for Medigap purposes.

Table 26: Loop 2330A NM1/Item 9 fields
Other Insured’s NameSource

Enter the last name, first name, and middle initial of the enrollee in a Medigap policy if the enrollee is different from the name shown in Item 2 Patient’s Name. Otherwise, enter the word Same. If no Medigap benefits are assigned, leave blank.

For the 837P, enter the Insured’s Name in Loop 2330A NM1 and in Item 9 of the Form CMS-1500.

Item 9 & its sub-items, 9a & 9d, apply to Medigap only.

Patient records

Only participating health care professionals and suppliers complete Item 9 Other Insured’s Name and its subdivisions and only when patients assign their rights to payment to the provider for Medigap purposes.

Note: This procedure only applies to the 12 Medigap plans that don't submit eligibility files to the Benefits Coordination & Recovery Center (BCRC) to trigger Medicare’s claims crossover process.