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Patient Relationship Codes Required On Claim Form

Release Date: January 10, 2013

Blue Cross and Blue Shield of North Carolina (BCBSNC) reminds providers for accurate claims adjudication, accurate reporting of the patient’s relationship to the insured (as appropriate) for services rendered to a dependent is required.

Electronic and paper submitted claims should be submitted using the patient information in addition to the insured when applicable.

Paper Claim Submitters - Patient relationship to insured should be reported in box 6 on CMS1500 for professional claims. Providers submitting UB04 claims should report patient relationship to insured in field locator 59 for institutional claims.  

Electronic Claim Submitters – When the patient can be uniquely identified by their member id, only loop 2010BA should be used.  Information required for this loop include: patient name, patient ID, patient DOB, patient gender, and patient address and should be sent along with a patient relationship to insured of 18- meaning self.  The patient relationship to the insured is sent in the SBR02 element.

Patients that cannot be uniquely identified by their member id, must have claims submitted with the insured name and insured ID in loop 2010BA.  The dependent loop 2010CA including the patient relationship to insured, patient name, patient address, patient DOB, and patient gender must also be sent.  The patient relationship to the insured should be sent in the PAT01 element.

Instructions for electronic submitters apply to both professional and institutional claim types.

If an error is identified in the patient relationship post adjudication, a corrected claim should be submitted via the applicable submission method (paper or electronic) as outlined in the Blue Book e-manual for providers available at bcbsnc.com/providers.