*Loops will vary by Payer*

Electronic Location:
Loop 2300
"Claim Information"

Segments

*Loops will vary by Payer*

Electronic Location:
Loop 2320
"Other Insured Info"

Segments

Medisoft Location for Paper Claims

Box 13

Any information printed in the box is determined by the Patient/Guarantor window, Other Information, Signature on File field. If this box is activated, what prints is determined by the Insured Signature on File filled in on the Insurance Carrier window, Options and Codes tab . If the "Signature on file" is selected, the words Signature on file print. If "Print Name" is selected, the insured name prints here. If "Leave Blank" is selected, the box is left blank.