Box 9 refers to a Patient’s Secondary Insurance Policy (if they have one).
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Box 9- Other Insured’s Name
What’s in the box?
The Last Name, First Name, and Middle Initial of the Insured (Policyholder) for the Patient’s Secondary Insurance Policy.
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 the Patient’s Secondary Insurance Policy. If the Policy is set to Self, Jane will use the Last Name, First Name, and Middle Initial (if present) in the Patient’s Profile. To adjust the patient’s name, head to their profile and click Edit/Settings.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, Jane will use the Last Name, First Name, and Middle Initial (if present) in the Patient’s Profile. To adjust the patient’s name, head to their 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 Name of the Insured can be added directly to the Policy, under the Insured’s Info heading.
Is this required?
The Other Insured’s first name and last name are required on the CMS1500. The Other Insured’s Middle Initial is optional.
The Other Insured’s first name and last name are required when billing via EDI file. The Other Insured’s Middle Name/Initial is optional.
What about the EDI file?
The Other Insured/Subscriber’s Name - whether it’s the Patient or a Spouse, Child, or Other - is sent in Loop 2330A - Other Subscriber Name.
- The Other Insured’s Last Name is sent in Loop 2330A - Other Subscriber Name, Segment NM103
- The Other Insured’s First Name is sent in Loop 2330A - Other Subscriber Name, Segment NM104
- The Other Insured’s Middle Name is sent in Loop 2330A - Other Subscriber Name, Segment NM105
Box 9a- Other Insured’s Policy or Group Number
What’s in the box?
The Policy, Group, or Plan Number of the patient’s Secondary Insurance Policy.
Where does this info live in Jane?
If a patient has Secondary Insurance coverage, then Jane will include the Policy/Group Number or the Member ID entered in the patient’s Secondary Policy in box 9a when submitting to the patient’s primary Insurance.
If there is a Policy/Group Number in the Secondary Policy, then it will be used. If there is not a Policy/Group Number in the secondary Policy, then the Member ID will be used instead.
To adjust a patient’s secondary Policy, head to Profile > Billing tab > Insurance Policies > View or New Insurance Policy.
Is this required?
When creating Insurance Policies in Jane: Member IDs are required. Policy/Group Numbers are optional.
What about the EDI file?
Primary Claims
If a patient has secondary coverage, then the Other Insured’s Policy/Group number (currently Member ID of secondary policy) will be sent in Loop 2320 - Other Subscriber Info, Segment SBR03
Example: Info in secondary Policy
📍 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 9b- Insurance Plan Name or Program Name
What’s in the box?
The Insurance Plan Name of the patient’s Secondary Insurance Policy.
Where does this info live in Jane?
The Other Insured’s Insurance Plan Name is set within the patient’s Secondary Insurance Policy. To adjust this, head to Profile > Billing tab > Insurance Policies > View or New Insurance Policy.
Is this required?
The Insurance Plan Name is optional when saving the patient’s Secondary Insurance Policy in Jane.
The Insurance Plan Name is optional when generating a CMS1500 to bill to a patient’s primary insurance. Box 9d will always be blank if the patient does not have secondary insurance.
The Insurance Plan Name is optional when submitting via EDI to bill to a patient’s primary insurance. Box 9d won’t be sent if the patient does not have secondary insurance.
What about the EDI file?
Primary Claims
If present in the patient’s secondary policy, the Insurance Plan Name is included in Loop 2330 - Other Subscriber Info, 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)