HCFA-1500 Box 6 - Patient Relationship to Insured
September 09, 2024On 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.
HCFA-1500 Box 5 - Patient's Address
August 29, 2024On the HCFA-1500 form, box 5 is designated for the patient's street address, city, state, zip code and telephone number. This is the patient who the services were rendered to for the claim.
HCFA-1500 Box 4 - Insured's Name
August 21, 2024On the HCFA-1500 form, box 4 is designated for the insured's name (Last, First, Middle). This is the subscriber of 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.
HCFA-1500 Box 3 - Patient's Birth Date and Sex
February 08, 2024On the HCFA-1500 form, box 3 is designated for the patient's birth date and sex. This is the patient who the services were rendered to for the claim. Check the box for the patient's sex and enter the patient's birth date using the complete 4-digit year.
HCFA-1500 Box 2 - Patient's Name
January 29, 2024On 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.