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Field 6 - Patient Relationship to Insured
Posted by Dan Perrine, Last modified by Dan Perrine on 28 March 2018 05:30 AM

The “Patient Relationship to Insured” indicates how the patient is related to the insured. “Self” would indicate that the insured is the patient. “Spouse” would indicate that the patient is the husband or wife or qualified partner, as defined by the insured’s plan. “Child” would indicate that the patient is the minor dependent, as defined by the insured’s plan. “Other” would indicate that the patient is other than the self, spouse, or child, which may include employee, ward, or dependent, as defined by the insured’s plan.

INSTRUCTIONS: Enter an X in the correct box to indicate the patient’s relationship to insured when Item Number 4 is completed. Only one box can be marked.

If the patient is a dependent, but has a unique Member Identification Number and the payer requires the identification number be reported on the claim, then report “Self”, since the patient is reported as the insured.

MEDICARE - Check the appropriate box for patient's relationship to insured when item 4 is completed.

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