HCFA-1500 Box 9 - Other Insured's Name

On the HCFA-1500 form, box 9 is designated for the other insured's name (Last, First, Middle). This refers to the subscriber of the patient's secondary insurance, for whom services were rendered. The name should be entered exactly as it appears on the subscriber's card.

Completing this box is an indication that the patient has insurance coverage under a secondary policy.

Tip: If box 9 is populated, you must also mark box 11d, which in turn requires you to populate boxes 9, 9a, and 9d.

In our example below, we populated box 9 with the name 'Smith, John'. The name should follow the format (Last, First, Middle), with a comma separating the Last and First Names.

Note: Follow the designated name order on the form, if provided; otherwise, use general naming order conventions. Consistency in name order across all claims is important to ensure successful name translation mapping.

So far, we've discussed the other insured's name box on the HCFA form and the information used to populate it. In the next section, we'll briefly cover the other insured's name box in relation to the X12 837 format.

In the X12 837 format, the other insured's name information is placed in the 2330A Other Subscriber Name Loop - NM1 segment. Specifically, the HCFA box 9 other insured's name data is mapped to the NM103, NM104, NM105, and NM107 segment/data elements.

The 2330A Other Subscriber Name Loop is required when the 2320 Other Subscriber Information Loop is used. Loop 2320 corresponds to HCFA Box 11d, which asks if there is another health plan.

The example below shows the 2330A Other Subscriber Name Loop - NM1 segment. The NM102 entity type is set to '1' for person, so the NM103 (subscriber last name) and NM104 (other subscriber first name) are populated.

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

Sample 837P (5010) - 2330A - Other Subscriber Name

Sample 837P (5010) - 2330A - Other Subscriber Name

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
• HCFA-1500 Box 7 - Insured's Address
• HCFA-1500 Box 8 - Reserved For NUCC Use
• HCFA-1500 Box 9 - Other Insured's Name [You are Here]

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