Jane's Guide Here's all the help you need to use Jane.

Box 12

Patient Release of Information

What’s in the box?

This box contains the patient’s (or authorized person’s) signature. It is left blank if the patient does not authorize the release of their medical information to process the claim.

It can contain the patient’s actual signature or Jane can populate the form with ‘SOF’ (Signature on File). By signing this release, the patient authorizes the release of any medical or other information necessary to process the claim. Additionally, if signed, it tells the Insurer that the patient requests the payment be sent to themselves or the party Accepting Assignment.

📍Pro Tip Note that Box 12 and Box 13 are similar, but it is important to understand the difference between the two boxes. Box 13 concerns the Insured’s permission, while Box 12 concerns the Patient’s permission. Often times the Patient is the Insured, but not always.

Where does this info live in Jane?

When creating or editing a patient Insurance Policy (Patient Profile> Billing > Insurance Policies), you’ll be asked if you have the patient’s consent to release medical information under a section labelled Patient Release of Information. To indicate that you’ve collected the patient’s consent to release medical information to process the claim, click the ‘Yes’ button.

Note that ‘Yes’ is the default when creating a new Policy.

If ‘Yes’ is selected in a patient’s Policy, then Box 12 on CMS1500 claims will include ‘SOF’ on the Signature line, and the Date line will contain the date the claim form was generated.

If instead ‘No’ is selected in a patient’s Policy, then the Date and Signature lines in Box 12 will be left blank when generating CMS1500 claims.

Things we’ve heard about Box 12 👂 Some clinics that Courtesy Bill have communicated that they are required to check ‘No’ in Box 12 if they don’t accept an Insurer’s assignment, and thus don’t want to get paid by the Insurer.

Apparently, sometimes just checking ‘No’ under Accept Assignment Box 27 isn’t enough - and thus some Insurers will still end up sending money to the clinic instead of directly to the patient if Box 12 isn’t set to ‘No’ in addition to Box 27 being set to ‘No’.

That said, it’s best to check with the Insurance company directly for more information if you do not Accept Assignment, but they continue to send you money.

Is this required?

You are required to check either Yes or No when saving a patient Insurance Policy (checking neither is not an option). When creating a new Policy, Yes will be checked by default.


What about the EDI file?

The Patient Release of Information is sent in Loop 2300 - Claim Info.

Specifically:

  • If Patient Release of Information is set to Yes in the policy, then a ‘Y’ is sent in Loop 2300, Segment CLM09
  • If Patient Release of Information is set to No in the policy, then a ‘I’ is sent in Loop 2300, Segment CLM09
  • Note that the Date that appears on Box 12 the CMS1500 does not have an equivalent area on EDI files. Thus the date associated with the patient’s release of information is not included (because it is not necessary) in EDI submissions.

📌 Pro Tip: Patient’s With Secondary Insurance

If a patient has secondary Insurance, the Patient Release of Information that is set in the secondary Policy is included in the EDI file that is sent to the primary payer.

The Secondary (other) Policy Patient Release of Information is sent in Loop 2320, Other Subscriber Info, Segment OI06

Note: there is not a spot for this on the CMS1500.