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5.11 Other Insurance Claims Filing
The following information must be provided in the "Other Insurance" field on the paper claim and in the appropriate field of electronic claims. On the CMS-1500, Fields 9 or 11, and 29 must contain the appropriate information:
• Name of the other insurance resource
• Address of the other insurance resource
• Policy number and group number
• Policyholder
• Effective date if available
• Date of disposition by other insurance resource (used to calculate filing deadline)
• Payment or specific denial information
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