Stedi's CMS-1500 claim form now supports Other Insured's Information (Box 9, 9a, and 9d)
Claims
You can now include a secondary or tertiary payer's health plan information in the Other Insured's Information section (Box 9, 9a, and 9d) of the Stedi portal's CMS-1500 professional form. Previously, you couldn’t submit this information using the form.
You can access the new section by selecting Yes in Box 11d – Is there another health benefit plan?
Once the section is open, you can expand Additional details to enter other information about the plan, including but not limited to:
The payer.
The payer responsibility sequence number code – primary, secondary, tertiary, or unknown.
Relationship to the insured – self, spouse, child, or other. Relative to the person listed in Box 4 – Insured Name.
To add more plans, click + Other insured.
Selecting No in Box 11d collapses the Other Insured's Information section and excludes its fields from the submitted claim. Any values you entered won't be included in the claim.
Coordination of benefits
Coordination of benefits (COB) is how payers divide responsibility for payment when a patient is covered by more than one insurance plan, such as a child covered under both parents' health plans.
In COB, the primary payer processes the claim first, then passes any remaining balance to the secondary payer, and so on.
The information in the Other Insured's Information section lets the primary payer see the patient's other plans so payment can be coordinated downstream.
Important: You can only use the CMS-1500 form to submit claims to primary payers. Submitting claims directly to a secondary or tertiary payer isn't supported.
