HCFA-1500 Box 2 - Patient's Name

On the HCFA-1500 form, box 2 is designated for the patient's name (Last, First, Middle). This is 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.

In our example below, we populated box 2 with the name 'Smith, John'. The name should be in the order of (Last, First, Middle) and use a comma to separate the Last and First Names.

Note: Follow the name order if there is one designated on the form, otherwise follow general naming order conventions. You want to keep the order consistent on every claim to ensure name translation mapping is successful.

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

In the X12 837 format, the patient's name box information goes in the 2010CA Patient Name Loop - NM1 segment. More specifically, the HCFA Box 2 patient's name data goes in the NM103, NM104, NM105 and NM107 segment/data elements. If the patient is the same person as the subscriber, then you would only send that information in the 2010BA Subscriber loop and not in the 2010CA Patient Loop.

The example below shows the 2010CA Patient Name Loop and the 2010BA Subscriber Name Loop - NM1 segment. Remember that you only send the 2010CA Patient Loop if the patient is not the same person as the subscriber. For additional information on the X12 837 format, we strongly recommend consulting the official X12 materials. Please refer to the HCFA box 4 Insured's Name document for more details and an example of the 2010BA Loop.

Sample 837P (5010) - 2010CA - Patient Name

Sample 837P (5010) - 2010BA - 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 [You are Here]
• HCFA-1500 Box 3 - Patient's Birth Date and Sex