CMS 1500 FORM Field 11 d - Is There Another Health Benefit Plan

Field 11 d - Is There Another Health Benefit Plan


“Is there another health benefit plan” indicates that the patient has insurance coverage other than the plan indicated in Item Number 1.

NUCC INSTRUCTIONS: When appropriate, enter an X in the correct box. If marked “YES”, complete 9, 9a, and 9d. Only one box can be marked.

MEDICARE INSTRUCTIONS - Leave blank. Not required by Medicare.

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