Skip to the box you’re looking for:
Box 11- Insured’s Policy, Group, or FECA Number
What’s in the box?
This box is for the Insured’s Policy, Group, or FECA number (if applicable). Note that this is different than the patient’s Member/Subscriber ID.
Example of an insurance card with a Group Number:
Where does this info live in Jane?
You can enter a patient’s Policy, Group, or Plan Number when creating or editing their Insurance Policy (Patient Profile> Billing > Insurance Policies).
Is this required?
A Policy, Group, or Plan Number is optional when saving a patient Insurance Policy in Jane.
Not all Insurance Policies have Group Numbers, but some Insurance companies require Group Numbers to be included on claim submissions. Check with the Insurer if you’re unsure if a Group Number is required.
What about the EDI file?
If present in the patient’s primary Insurance Policy, the Policy/Group Number is sent to Loop 2000B - Subscriber Info.
Specifically:
- The Policy/Group Number is sent to Loop 2000B, Segment SBR03
📍 Pro Tip
Some Insurance companies will reject claims if you include both the Policy/Group Number (SBR03) and the Insurance Plan Name (SBR04). In these cases, it is recommended that you only include the Policy/Group Number in the patient’s Insurance Policy (Patient Profile> Billing > Insurance Policies).
This rule applies to both primary and secondary Policies.
Policy/Group Number: Box 11 (primary), Box 9a (secondary)
Insurance Plan Name: Box 11c (primary), Box 9d (secondary)
Box 11a- Insured’s DOB and Legal Sex
What’s in the box?
This box indicates the Insured’s (policyholder’s) date of birth and legal sex. If the patient is the Insured, then this box will show the same information as Box 3.
This may be different than the patient’s gender. The legal sex is what the Insurance company has on file for the patient.
Where does this info live in Jane?
This depends on whether the patient is the Insured or not. This can be found by heading to the Patient Profile> Billing> Insurance policies and clicking View on an existing Policy or creating a New Insurance Policy. Under the Insured’s Info heading, you can use the drop-down menu to set the Patient Relationship to Insured.
If the Patient is the Insured: set Patient Relationship to ‘Self’
If the Policy is set to Self, then Jane will use the Birth Date and Sex entered in the Patient’s Profile. To adjust theses, head to the Patient Profile and click Edit/Settings.
If the Patient is not the Insured: set Patient Relationship to the appropriate status
If the Patient Relationship to Insured is set to something other than Self, then the Birth Date and Sex of the Insured can be added directly to the Policy, under the Insured’s Info heading.
Is this required?
Yes. You need to send the Member/Insured’s date of birth and legal sex in your CMS1500 and EDI claim submissions.
What about the EDI file?
The Member/Insured’s DOB and Legal Sex are sent in Loop 2000B - Subscriber.
- The date of birth is sent in Loop 2010BA - Subscriber Info, Segment DMG02
- The legal sex is sent in Loop 2010BA - Subscriber Info, Segment DMG03
Note the following qualifiers for each Legal Sex option:
- Male= M
- Female= F
- X= U
Box 11c- Insurance Plan Name
What’s in the box?
If applicable, the name of the patient’s Insurance plan or the program ID of the Insured. This box is conditionally required depending on the primary Insurer’s requirements. Some payers will require an identification number in this field.
Where does this info live in Jane?
The Insurance Plan Name can be entered when creating or editing a Policy for a patient (Profile > Billing tab > Insurance Policies > View or New Insurance Policy).
Is this required?
This is an optional field when creating an Insurance Policy in Jane.
This is an optional field on the CMS1500.
This is an optional field when billing via EDI file.
What about the EDI file?
If included in the patient’s primary Policy, the Insurance Plan Name is sent in the Loop 2000B - Subscriber Info
Specifically:
- The Insurance Plan Name is sent in Loop 2000B, Segment SBR04
📍 Pro Tip
Some Insurance companies will reject claims if you include both the Policy/Group Number (SBR03) and the Insurance Plan Name (SBR04). In these cases, it is recommended that you only include the Policy/Group Number in the patient’s Insurance Policy (Patient Profile> Billing > Insurance Policies).
This rule applies to both primary and secondary Policies.
Policy/Group Number: Box 11 (primary), Box 9a (secondary)
Insurance Plan Name: Box 11c (primary), Box 9d (secondary)
Box 11d- Is there a Secondary Insurer?
What’s in the box?
This box indicates whether or not the patient is covered by an additional Insurance Policy. If ‘Yes’ is checked, typically Box 9 will also be filled out.
Where does this info live in Jane?
‘Yes’ will be checked on the CMS1500 if there are at least two Policies added to the patient’s Appointment.
If only a primary Policy is present, then ‘No’ will be checked on the CMS1500.
📍 Pro Tip
Note that if ‘Yes’ is checked, that doesn’t guarantee that Box 9 will also be filled out on the CMS1500. Box 9 and Box 9a are populated with required fields from the secondary Policy, so they will always be present. However, since the Insurance Plan Name is optional when saving an Insurance Policy, it’s possible for Box 9b to be absent from the submission.
Is this required?
As long as the Appointment you’re working with has more than 1 Insurance Policy added, Box 11d will be set to ‘Yes’.
What about the EDI file?
This box does not correspond to an element of an 837 file.
That being said, if the SBR segment in Loop 2320 - Other Subscriber Info is present in an EDI file, that means that the patient has an additional Insurance Policy. Just note that there isn’t an element in that (or any other) segment that corresponds to Box 11d on the CMS1500.