Electronic loop for patient name, id, Sex, Birthdate of cms 1500

Item 1a*    Enter the patient’s Medicare HIC number whether Medicare is the primary or secondary payer.

Use the number shown on the Medicare card.

Electronic:

2010BA    NM101    Insured or Subscriber
    NM102    Person
    NM108    Medicare Identification Number
    NM109    Medicare Primary Identifier

Item 2*

Enter the patient’s last name, first name and middle initial, if any, as shown on the patient’s Medicare card.

Use the name as it appears on the Medicare card.

Electronic:

2010BA    NM103    Last Name
    NM104    First Name
    NM105    Middle Name

Item 3

Enter the patient’s eight-digit birth date (MM/DD/CCYY) and sex

Electronic:

2010BA    DMG02    Birth Date
    DMG03    Gender