HCFA-1500 Box 6 - Patient Relationship to Insured

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.

In our example below, we checked box 6 as 'Self'. This means that the patient/subscriber are the same person.

Note: When the patient/subscriber are the same - box 6 would be checked 'Self', you often don't have to complete the insured address in box 7.

So far, we talked about what the patient relationship to insured box on the HCFA form is and the information used to populate this location. In the next section, we'll briefly discuss the patient relationship to insured box in relation to the X12 837 format.

In the X12 837 format, the location of the patient relationship to insured box depends on the value in box 6. If the patient/subscriber are the same, then the information goes in the 2000B Subscriber Information Loop - SBR segment. More specifically, the HCFA box 6 patient relationship to insured data goes in the SBR02 segment/data element - Individual Relationship Code - the value is '18' for 'Self'.

If the patient/subscriber are not the same, then the information goes in the 2000C Patient Information Loop - PAT01 segment/data element - Individual Relationship Code. Please refer to the x12 guide as there are multiple values (example: 01 = Spouse).

The example below shows both the 2000B Subscriber Information Loop - SBR02 and the 2000C Patient Information Loop - PAT01 segment/data elements.

For additional information on the X12 837 format, we strongly recommend consulting the official X12 materials.

Sample 837P (4010/5010) - 2000B - Subscriber Information

Sample 837P (4010/5010) - 2000C - Patient Information

HCFA-1500 Form Box Locations

• HCFA-1500 Box 0 - Carrier Block
• HCFA-1500 Box 1 - Insurance Type
• HCFA-1500 Box 1a - Insured's ID Number
• HCFA-1500 Box 2 - Patient's Name
• HCFA-1500 Box 3 - Patient's Birth Date and Sex
• HCFA-1500 Box 4 - Insured's Name
• HCFA-1500 Box 5 - Patient's Address
• HCFA-1500 Box 6 - Patient Relationship to Insured [You are Here]
• HCFA-1500 Box 7 - Insured's Address
• HCFA-1500 Box 8 - Reserved For NUCC Use

Grab a sample of the HCFA-1500 claim form here - HCFA 02/12 Claim Form