Insurer Info & Claim Destination

What’s in the box?

This area of the form holds the Legal Name and Full Address of the payer (Insurer) that is being billed. It indicates where the claim will be sent.

Where does this info live in Jane?

The Insurer Legal Name and Address are set when creating or editing an Insurer in Settings > Insurers. The screenshot below shows which fields in the Insurer Settings correspond to the info in this box:

Is this required?

For paper claims, this information should be treated as required. We should mention that if you don’t add a Legal Name in the Insurer Settings, your internal Insurer Name will be used instead.

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What about the EDI file?

This information is sent in Loop 2010BB - Payer Name

• The Insurer Legal Name is sent in Loop 2010BB, Segment NM103
  • Note that NM101 is hardcoded to PR, which means Payer.
  • Note that NM102 is hardcoded to 2, which identifies the Payer as an Organization (rather than an Individual).
  • Note that NM109 is the Insurer Payer ID.
• The Insurer Address is sent in Loop 2010BB, Segments N3 & N4
  • The Street Address is sent in N301.
  • The City, State, and Zip Code is sent in N401, N402, and N403 respectively.

Note that the Insurer Legal Name is also used in Loop 1000B Receiver Info, Segment NM101

📍 Key Note: CMS1500 vs EDI

For electronic claims, you are required to have one or both of the following for the patient’s primary Insurance:

1) Full Insurer Address

2) Payer ID (also set in Settings > Insurers)

When submitting an electronic claim for a patient with dual coverage, a Payer ID for the secondary Insurer is required. If the secondary payer needs to be biller via paper, then enter the ‘PAPER’ as the Payer ID.

Paper claims don’t consider the Payer ID. Only the Insurer address is used!