Field 11 c - Insurance Plan Name or Program Name

The “Insurance Plan Name or Program Name” is the name of the
plan or program of the insured as indicated in Item Number 1a.
NUCC INSTRUCTIONS: Enter the name of the insurance
plan or program of the insured. Some payers require an identification number of
the primary insurer rather than the name in this field.
MEDICARE INSTRUCTIONS - Enter the 9-digit
PAYERID number of the primary insurer. If no PAYERID number exists, then enter
the complete primary payer's program or plan name. If the primary payer's EOB
does not contain the claims processing address, record the primary payer's
claims processing address directly on the EOB. This is required if there is
insurance primary to Medicare that is indicated in item 11.
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Field 9 - Other Insured's Name
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Field 17 - Name of Referring Provider or Other Source
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