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CMS-1500
Block 1-13
Term | Definition |
---|---|
1 | Coverage |
1a | Insured's ID number |
2 | Patient's name |
3 | Patient's birth date and gender |
4 | Insured's name |
5 | Patient's address, city, state, zip code and phone # |
6 | Patient's relationship to the insured |
7 | Insured's address, city, state, zip code and phone # |
8 | Reserved for NUCC use |
9 | Other insured's name |
9a | Other insured's policy or group number |
9b | Reserved for NUCC use |
9c | Reserved for NUCC use |
9d | Other insured's insurance plan or name |
10a-c |