Tips for Submitting Claims for US Family Health Plan Patients

For Subscriber/Members

Each US Family Health Plan member has a unique identification number. When submitting a claim for a patient who is the subscriber, include the following details:

• Patient Last Name: 2010BA NM103
• Patient First Name: 2010BA NM104
• Patient code qualifier "MI": 2010BA NM108
• Patient ID #: 2010BA NM109
• Patient Date of Birth: 2010BA DMG02
• Patient Gender: 2010BA DMG03

For Newborns Without a Member ID

(Dependent of US Family Health Plan Subscriber/Member)

If the patient is a newborn who does not yet have a member ID number, submit the claim using the following fields in Loop 2010BA (Subscriber) and Loop 2010CA (Patient):

• Subscriber Last Name: 2010BA NM103
• Subscriber First Name: 2010BA NM104
• Subscriber Code Qualifier ("MI"): 2010BA NM108
• Subscriber ID #: 2010BA NM109
• Subscriber Date of Birth: 2010BA DMG02
• Subscriber Gender: 2010BA DMG03
• Patient Last Name: 2010CA NM103
• Patient First Name: 2010CA NM104
• Patient Date of Birth: 2010CA DMG02
• Patient Gender: 2010CA DMG03