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On the HCFA-1500 form, box 8 is designated Reserved For NUCC Use. This box was previously used for the patient status (single, married, other, employed, full-time student, part-time student). There is no location in the 837P format that corresponds to this HCFA location.
On the HCFA-1500 form, box 7 is designated for the insured's street address, city, state, zip code and telephone number. This is the subscriber of the patient who the services were rendered to on the claim.
On the HCFA-1500 form, box 6 is designated for the patient relationship to insured (Self, Spouse, Child, Other). This location describes how the patient is related to the insured. Only one box can be selected.
On the HCFA-1500 form, box 5 is designated for the patient's street address, city, state, zip code and telephone number. This is the patient who the services were rendered to for the claim.
On the HCFA-1500 form, box 4 is designated for the insured's name (Last, First, Middle). This is the subscriber of the patient who the services were rendered to for the claim. The name should be entered exactly as it appears on the patient's member card.
On the HCFA-1500 form, box 3 is designated for the patient's birth date and sex. This is the patient who the services were rendered to for the claim. Check the box for the patient's sex and enter the patient's birth date using the complete 4-digit year.
