Box 58a, 58b, 58c - Insured's Name

Box Definition

Boxes 58a, 58b, and 58c on the UB-04 are where the insured's name is shown.

• A - Primary
• B - Secondary
• C - Tertiary

In AveaOffice

To change the insured's name on the claim form:

1. Navigate to the patient's Intake > Insurance tab.
2. Click into the insurance set primary payer for the claim.
3. Go to the Policy Holder tab.
4. Click Edit.
5. Edit the Subscriber First Name and Last Name fields.
   
6. Click Save.

EDI Loop/Segment

Loop 2010BA, Segment NM1

Qualifier IL