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Get and Sign Professional Claim Form 2012-2022

Get and Sign Professional Claim Form 2012-2022

Use a claim field 2012 template to make your document workflow more streamlined.

Location Description Electronic Segment Example Electronic Segment Information FL 1 a INSURED’S ID NUMBER: Group Health 8-digit Member ID Loop 2010BA: NM109 NM1*IL*1*DOE*JOHN *T**JR*MI*123456~ X12 transaction segment type is NM1. NM101=IL is for insured/subscriber, NM102 is 1 and means person, NM103=Doe is the subscriber’s last name, NM104=John is subscriber’s first name, NM105=T is subscribers middle initial, NM107=JR is subscriber’s suffix, NM108=MI indicates it is a member...
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