Patient’s Date of Birth & Legal Sex
What’s in the box?
This box indicates the patient’s date of birth and legal sex.
Legal sex 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?
A patient’s birth date and legal sex are set within their Patient Profile. To adjust these, head into the Edit/Settings tab and scroll down to find the Birth Date and Sex fields.
Note: there are three options to choose from in Jane: Male, Female, and X. If X is selected, then neither the ‘F’ or ‘M’ boxes on the CMS1500 will be checked. The Gender field will not be used in claim submissions.
Is this required?
Both the patient’s DOB and Legal Sex are optional on the CMS1500 and in Jane.
Both the patient’s DOB and Legal Sex are required when billing via EDI file.
What about the EDI file?
Although the patient’s first and last name are always required, where this information is sent in the EDI is situational:
Option 1: Patient is the Subscriber
If the patient is also the Subscriber (the patient is the one who holds the Insurance Policy), then Loop 2000C - Patient is not sent in the EDI. Thus, the patient DOB and Legal Sex are sent in Loop 2000B - Subscriber.
- The patient’s date of birth is sent in Loop 2010BA - Subscriber Info, Segment DMG02
- The patient’s legal sex is sent in Loop 2010BA - Subscriber Info, Segment DMG03
Option 2: Patient is not the Subscriber
If the patient is not the subscriber (i.e. their spouse is the Policyholder and they are covered under that Policy), then the patient’s DOB and Legal Sex are sent in Loop 2000C - Patient.
- The patient’s date of birth is sent in Loop 2010CA - Patient Info, Segment DMG02
- The patient’s legal sex is sent in Loop 2010CA - Patient Info, Segment DMG03
Note: the patient’s birthdate gets sent in year/month/day format (i.e 1992/11/19)
Note: the following qualifiers for each Legal Sex option:
- Male= M
- Female= F
- X= U