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Field 11 b - Other Claim ID
Posted by Dan Perrine, Last modified by Dan Perrine on 28 March 2018 06:51 AM

The “Other Claim ID” is another identifier applicable to the claim.

INSTRUCTIONS: Enter the “Other Claim ID.” Applicable claim identifiers are designated by the NUCC.

When submitting to Property and Casualty payers, e.g. Automobile, Homeowner’s, or Workers’ Compensation insurers and related entities, the following qualifier and accompanying identifier has been designated for use:

Y4 Agency Claim Number (Property Casualty Claim Number)

Enter the qualifier to the left of the vertical, dotted line. Enter the identifier number to the right of the vertical, dotted line.

FOR WORKERS’ COMPENSATION OR PROPERTY & CASUALTY: Required if known. Enter the claim number assigned by the payer.

MEDICARE - Form version 08/05: Enter employer's name, if applicable. If there is a change in the insured's insurance status, e.g., retired, enter either a 6-digit (MM | DD | YY) or 8-digit (MM | DD | CCYY) retirement date preceded by the word, "RETIRED."

Form version 02/12: provide this information to the right of the vertical dotted line.

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