|
| |
Claimant Information
This section provides
information about the claimant. These fields are optional with the
exception of the claimant age and sex when the claim is closed with an indemnity
payment. Nevertheless, please try to enter all fields where the
information is known. All information regarding the claimant must reflect
the claimant's status at the time of the incident.
| NOTE: |
When a claim
is filed involving a bad outcome during delivery, the claimant can
either be the mother or the child. Please be sure to code all
fields in this section for the claimant you elect to use. All
codes must be consistent for either the mother or the child. |
| Field
No. |
Field
Name |
Entry |
Description |
| 9 |
Age |
Required |
This field
is required when the file is closed with an indemnity payment,
otherwise optional. Optional for corporate files. Enter the
claimant's age from the following table. If age is unknown, leave
blank. |
| Code |
Claimant
Age |
| -1 |
For
Non-Person or Age of patient is unknown (can be used for Corporate
claims) |
| -999 |
Newborn;
claim involves perinatal period |
| 00 |
After
perinatal period but less than one year old |
| 01-99 |
Age
(in years) as of the incident date |
| 99 |
For
age 100 or older |
|
Table
3-A |
| Field
No. |
Field
Name |
Entry |
Description |
| 10 |
Sex |
Required |
This field
is required when the file is closed with an indemnity payment,
otherwise optional. Optional for corporate files. Enter the
claimant's sex from the following table. |
| Code |
Sex |
| f |
Female |
| m |
Male |
| u |
Unknown |
|
Table
3-B |
| Field
No. |
Field
Name |
Entry |
Description |
| 11 |
Collateral
Source |
Optional |
Enter the
claimant compensation benefits from the following table. |
| Code |
Collateral
Source |
| 1 |
Medicaid |
| 2 |
Medicare |
| 3 |
Private
Insurance |
| 4 |
Workers'
Compensation |
| 5 |
Unknown |
| 6 |
Other |
| 7 |
None |
|
Table
3-C |
|
