*Loops will vary by Payer*

Electronic Location:
Loop 2300
"Claim Information"

Segments

Medisoft Location for Paper Claims

Box 12

Prints the date . This information comes from the Patient Guarantor window, Other Information tab, Signature date field. Whether any information printed in this box is determined in the Patient/Guarantor window, Other Information tab, Signature On File field. If this box is activated, what prints is determined by the Patient Signature on File field in the Insurance Carrier entry window, Options and Codes tab. If the selection in the Insurance Carrier entry window is "Signature on file," the words "Signature on file" are printed in this box; if the selection is "Print name," the patient's name is printed; and if the selection is "Leave blank," the box is left blank.