Field 13 - Insured’s or Authorized Person’s Signature
The “Insured’s or Authorized Person’s Signature” indicates that there is a signature on file authorizing payment of medical benefits.
NUCC INSTRUCTIONS: Enter “Signature on File,” “SOF,” or legal signature. If there is no signature on file, leave blank or enter “No Signature on File.”
MEDICARE INSTRUCTIONS - The patient’s
signature or the statement “signature on file” in this item authorizes payment
of medical benefits to the physician or supplier. The patient or his/her
authorized representative signs this item or the signature must be on file
separately with the provider as an authorization. However, note that when
payment under the Act can only be made on an assignment-related basis or when
payment is for services furnished by a participating physician or supplier, a
patient’s signature or a “signature on file” is not required in order for Medicare
payment to be made directly to the physician or supplier.
The presence of or lack of a signature or “signature on file” in this field
will be indicated as such to any downstream coordination of benefits trading
partners (supplemental insurers) with whom CMS has a payer-to-payer
coordination of benefits relationship. Medicare has no control over how
supplemental claims are processed, so it is important that providers accurately
address this field as it may affect supplemental payments to providers and/or
their patients.
In addition, the signature in this item authorizes payment of mandated Medigap
benefits to the participating physician or supplier if required Medigap
information is included in item 9 and its subdivisions. The patient or his/her
authorized representative signs this item or the signature must be on file as a
separate Medigap authorization. The Medigap assignment on file in the
participating provider of service/supplier's office must be insurer specific.
It may state that the authorization applies to all occasions of service until
it is revoked.
NOTE: This can be "Signature on File" signature and/or a computer
generated signature.
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