ED053

Codes indicating the relationship — such as patient, spouse, child, etc. — of the patient to the identified insured person listed in the first of three Insured’s Name fields.

18 = Patient is named insured

1 = Spouse

19 = Natural Child/insured financially responsible

43 = Natural Child/insured does not have financial responsibility

17 = Step Child

10 = Foster Child

15 = Ward of the Court — Patient is ward of the insured as a result of a court order

20 = Employee — The patient is employed by the named insured

21 = Unknown — The patient’s relationship to the named insured is unknown

22 = Handicapped Dependent — Dependent child whose coverage extends beyond normal termination age limits as a result of laws or agreements extending coverage

39 = Organ Donor — Code is used in cases where bill is submitted for care given to organ donor where such care is paid by the receiving patient’s insurance coverage

40 = Cadaver Donor — Code is used where bill is submitted for procedures performed on cadaver donor where such procedures are paid by the receiving patient’s insurance coverage

5 = Grandchild

7 = Niece or Nephew

41 = Injured Plaintiff — Patient is claiming insurance as a result of injury covered by insured

23 = Sponsored Dependent — Individual not normally covered by insurance coverage but coverage has been specially arranged to include relationships such as grandparent or former spouse that would require further investigation by the payer

24 = Minor Dependent of a Minor Dependent — Code is used where patient is a minor and a dependent of another minor who in turn is a dependent, although not a child of the insured

32 = Mother

33 = Father

4 = Grandparent

29 = Significant Other

36 = Emancipated Minor

53 = Life Partner

G8 = Other Relationship