Patient Tab - Institutional

The Patient section for an institutional claim is different from a professional claim because of different requirements. This section is used to supply the patient information. This information is required when the patient is the subscriber or considered to be the subscriber and at least one of the element requirements is met.

The Patient fields are defined below:

Relationship to SubscriberRelationship to Subscriber

Code indicating the relationship of the patient to the person insured. Required when the patient is the subscriber or is considered to be the subscriber. Options are:

01	Spouse
18	Self
19	Child
20	Employee
21	Unknown
39	Organ Donor
40	Cadaver Donor
53	Life Partner
G8	Other Relationship

LastLast

Last name of the person to whom the services were provided.

FirstFirst

First name of the person to whom the services were provided.

InitInit

Middle initial of the patient.

SuffixSuffix

Additional descriptive information at the end of the patient's name (e.g. Jr.).

Address 1 & 2Address 1 & 2

Street number and name of the mailing address of the patient (or post office box number or RFD), and additional address information.

ZipZip

Postal code of the address where the patient lives. When a user enters a zip code in a zip code field and clicks tab to move to the next field, the city and state fields are automatically generated based on data received from the USPS. Note: This replaces any data already entered in the city/state fields.

CityCity

Name of the city where the patient lives.

StateState

Two-letter code for the state or province where the patient lives.

Country CodeCountry Code

The country where the patient lives.

Subdivision CodeSubdivision Code

Code identifying the country subdivision.

Birth DateBirth Date

The date of birth of the patient.

GenderGender

The gender of the patient as recorded at date of admission, outpatient service, or start of care. Options are:

F	Female
M	Male
U	Unknown

Patient Account NumberPatient Account Number

Patient’s unique alpha-numeric number assigned by the provider to facilitate retrieval of individual financial records and posting of the payment.

Medical Record NumberMedical Record Number

The number assigned to the patient’s medical/health record by the provider. Also called a chart number.

Statement From DateStatement From Date

The date of the start of the period covered on the claim.

Statement Thru DateStatement Thru Date

The date of the end of the period covered on the claim.

Admission DateAdmission Date

The date the patient was admitted to the provider for inpatient care, outpatient service, or start of care.

Admission HourAdmission Hour

Four digits for the hour and minute of admission.

Admission TypeAdmission Type

Code indicating the priority of the admission. Options are:

1	Emergency
2	Urgent
3	Elective
4	Newborn
5	Trauma Center Activation
9	Info Not Available

Admission SourceAdmission Source

Code indicating the source of this admission, such as physician referral. Options are:

1	Non-Health Care Facility Point of Origin
2	Clinic
4	Transfer from Hospital (Different Facility)
5	Born Inside this Hospital (For Newborns Only)
5	Transfer from SNF or ICF
6	Born Outside this Hospital (For Newborns Only)
6	Transfer from Another Health Care Facility
8	Court/Law Enforcement
9	Information Not Available
D	Transfer from One Unit to Another (Same Facility)
E	Transfer from Ambulatory Surgery Center
F	Transfer from Hospice and Under Hospice POC

Discharge HourDischarge Hour

Four digits for the hour and minute of discharge.

Patient Status Patient Status

A code indicating patient status as of the Statement Thru Date. Options are:

01	Discharged to Home or Self-Care (Routine)
02	Discharged/Transferred to Another Hospital
03	Discharged/Transferred to SNF
04	Discharged/Transferred to Intermediate Facility
05	Discharged/Transferred to Designated Cancer Center
06	Discharged/Transferred to Home Under Care of HH
07	Left Against Medical Advice/Discontinued Care
09	Admitted as an Inpatient to this Hospital
20	Expired (or Did Not Recover-Christian Science)
21	Discharge/Transfer to Court/Law Enforcement
30	Still Patient
40	Expired at Home
41	Expired at Medical Facility
42	Expired - Place Uknown
43	Discharged/Transferred to Federal Hospital
50	Hospice - Home
51	Hospice - Medical Facility
61	Discharged/Transferred to Medicare Swing Bed
62	Discharged/Transferred to Inpatient Rehab Facility
63	Discharged/Transferred to Long-Term Care Hosp
64	Discharged/Transferred to Nursing Facility
65	Discharged/Transferred to Psychiatric Hospital
66	Discharged/Transferred to Critical Access Hosp
70	Discharged/Transferred to Another Type Inst

Release of Information CodeRelease of Information Code

Code indicating whether the provider has on file a signed statement permitting the release of medical data to other organizations.

I	Informed Consent to Release Info
Y	Yes, Provider has Signed Statement

Delay Reason CodeDelay Reason Code

Code indicating the reason why a request was delayed. Options are:

1	Proof of Eligibility Unknown or Unavailable
2	Litigation
3	Authorization Delays
4	Delay in Certifying Provider
5	Delay in Supplying Billing Forms
6	Delay in Delivery of Custom-Made Appliances
7	Third-Party Processing Delay
8	Delay in Eligibility Determination
9	Original Claim Rejected or Denied Due to a Reason Unrelated to the Billing Limitation Rules
10	Administration Delay in the Prior Approval Process
11	Other
15	Natural Disaster

Property Claim NumberProperty Claim Number

Identification number for property casualty claim associated with the services identified on the bill.

Property Patient ID QualifierProperty Patient ID Qualifier

Code qualifying the reference identification for a property and casualty claim. Options are:

1W	Member ID Number
SY	Social Security Number

Property Patient IDProperty Patient ID

Identification number of the patient on a property and casualty claim.