HCFA-1500 Box 9 - Other Insured's Name
December 22, 2024
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]
- HCFA-1500 Box 9a - Other Insured's Policy or Group Number
- HCFA-1500 Box 9b - Reserved For NUCC Use
- HCFA-1500 Box 9c - Reserved For NUCC Use
- HCFA-1500 Box 9d - Insurance Plan Name or Program Name
- HCFA-1500 Box 10 - Is Patient's Condition Related To
- HCFA-1500 Box 10d - Claim Codes
- HCFA-1500 Box 11 - Insured's Policy Group or FECA Number
- HCFA-1500 Box 11a - Insured's Date of Birth and Sex
- HCFA-1500 Box 11b - Other Claim ID
- HCFA-1500 Box 11c - Insurance Plan Name or Program Name
- HCFA-1500 Box 11d - Is There Another Health Plan
- HCFA-1500 Box 12 - Patient's or Authorized Person's Signature
- HCFA-1500 Box 13 - Insured's or Authorized Person's Signature
- HCFA-1500 Box 14 - Date of Current Illness, Injury, Pregnancy (LMP)
- HCFA-1500 Box 15 - Other Date
- HCFA-1500 Box 16 - Dates Patient Unable to Work in Current Occupation
- HCFA-1500 Box 17 - Name of Referring Provider or Other Source
- HCFA-1500 Box 17a - Other ID
- HCFA-1500 Box 17b - NPI
- HCFA-1500 Box 18 - Hospitalization Dates Related to Current Services
- HCFA-1500 Box 19 - Additional Claim Information
- HCFA-1500 Box 20 - Outside Lab Charges
- HCFA-1500 Box 21 - Diagnosis or Nature of Illness or Injury
- HCFA-1500 Box 22 - Resubmission Code and Original Reference Number
- HCFA-1500 Box 23 - Prior Authorization Number
- HCFA-1500 Box 24a - Date(s) of Service
- HCFA-1500 Box 24b - Place of Service
- HCFA-1500 Box 24c - EMG
- HCFA-1500 Box 24d - Procedures, Services, or Supplies
- HCFA-1500 Box 24e - Diagnosis Pointer
- HCFA-1500 Box 24f - Charges
- HCFA-1500 Box 24g - Days or Units
- HCFA-1500 Box 24h - EPSDT/Family Plan
- HCFA-1500 Box 24i - Rendering Provider ID Qualifier
- HCFA-1500 Box 24j - Rendering Provider ID
- HCFA-1500 Box 25 - Federal Tax ID Number
- HCFA-1500 Box 26 - Patient's Account No.
- HCFA-1500 Box 27 - Accept Assignment
- HCFA-1500 Box 28 - Total Charge
- HCFA-1500 Box 29 - Amount Paid
- HCFA-1500 Box 30 - Rsvd for NUCC Use
- HCFA-1500 Box 31 - Signature of Physician or Supplier Including Degrees or Credentials
- HCFA-1500 Box 32 - Service Facility Location Information
Grab a sample of the HCFA-1500 claim form here - HCFA 02/12 Claim Form
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