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Back  RFI # 1073: Correct Patient/Insured Name

Formal vs. Informal Help Informal Formal

Submitter

Jan Klimper

Description

Note under patient name: When used and the information was submitted with the original claim, this segment must provide the information from the original claim. The Corrected Patient/Insured Name NM1 segment identifies the adjudicated Insured name and ID information if different than what was submitted on the claim.

Note under corrected PAT/INS name: Required when needed to provide corrected information about the patient or insured.

TR3 Notes: Since the patient is always the insured for Medicare and Medicaid, this segment always provides corrected patient information for Medicare and Medicaid. For other carriers, this will always be the corrected insured information.

Qualifier 74 is for corrected Insured.

Do we will only send the corrected insured information?

I.E. provider bills for patient Bob Jones, covered under Barb Jones policy as Robert Jones, we would not return Robert Jones in this field because he is not the insured and the provider billed Barb Jones as the insured correctly?

Submitter Assigned Keywords

Correct Patient Insured Name

Response

This issue is explicitly addressed in guide 005010X221. The Corrected Patient/Insured NM1 segment note states "Since the patient is always the insured for Medicare and Medicaid, this segment always provides corrected patient information for Medicare and Medicaid. For other carriers, this will always be the corrected insured information."

Therefore, for all payers that are not Medicare or Medicaid, this always represents the corrected insured. In fact, this is always the corrected insured - it is just that Medicare and Medicaid don't use that term. Corrected Patient information is only present when the patient IS the insured. Only send corrected insured information.

For your example, the Corrected Patient/Insured segment would not be used since the submitted insured information was correct.
Submission 6/11/2010
Status Date 7/2/2010
Status F - Final
Primary References
Document 005010X221
Section2100NM1
Page143
Set IDNM1
Loop2100
Segment PositionNM1