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Box 1

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Box 1- Insurance Coverage Type

What’s in the box?

This box is where you indicate which type of health insurance coverage the claim is being billed to. There are 7 options to choose from on the CMS1500— you’ll want to check the box that most accurately reflects the Insurer you’re billing to.

Where does this info live in Jane?

When creating or editing your Insurer in Settings > Insurers, the Insurance Program field will determine which option is checked in box 1.

Wondering if your Insurance Program is correct? You can do a quick check by heading into Settings > Insurers and check the brackets after “Type:

If something doesn’t look right, you can use the Edit button beside the Insurer to fix it up.

Once you’re in the Insurer Settings you can use the drop-down box next to Insurance Program to choose the correct coverage type.

Is this required?

This is an optional field on the CMS1500.

This is a required when billing via EDI file.


What about the EDI file?

Although there are only 7 Insurance plan types on the CMS1500, there are many more options that can be sent via EDI.

Here is a list of the Insurance programs we have listed in Jane. The list shows the qualifier that will get sent in the EDI file for each given Insurance program, and the equivalent of that qualifier when looking at a CMS1500 form.

If you don’t see an Insurance program called out on this list, then the “11” qualifier will be used in the EDI.

The Insurance program gets sent in Loop 2010BA - Subscriber Name

  • The Claim Filing Indicator Code is sent in Segment SBR09 on the EDI file.

 

Box 1a- Member/Insured’s ID Number

What’s in the box?

The Subscriber/Member Identification Number assigned to a Patient’s Insurance Policy by the Insurer.

Where does this info live in Jane?

This ID is added when creating a Patient’s Policy (Patient Profile > Billing tab > Insurance Policies > View or New Insurance Policy). It should go in the Subscriber/Member Identification Number field.

Is this required?

This is a required field when creating a Patient’s Insurance Policy in Jane.

This is a required field on the CMS1500.

This is a required field when billing via EDI file.


What about the EDI file?

This Member/Subscriber ID is sent in Loop 2010BA - Subscriber, Segment NM109