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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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