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Back  RFI # 442: Insured Name When Same as Pat.

Formal vs. Informal Help Informal Formal

Submitter

Bob Resh

Description

We are seeing a number of Payers always sending the Insured Name NM1 segment, even when the Insured is the Patient. When questioned, they state that the only restrictionbs in the guide are for Medicare and Medicaid. Since they are not a Medicare or Medicaid they can always send the Insured Name. Is that interpretation correct?

Submitter Assigned Keywords

Insured Patient Name

Response

The Insured NM1 segment is used to identify the insured or subscriber whenever the insured or subscriber is different from the patient. To use the Insured NM1 when the patient is the insured is redundant and not necessary. However the IG does not prohibit sending the Insured NM1 when the patient is the insured, except for Medicare and Medicaid payers.
Submission 8/18/2006
Status Date 10/20/2006
Status F - Final
Primary References
Document 004010X091A1
Section3
Page105
Set ID835
Table2
Loop2100
Segment Position030
Segment IDNM1
Industry NameInsured Name