Submitting Claims for Non-Binary Members

Harvard Pilgrim would like to offer some clarification regarding the proper method of billing for services related to non-binary members, specifically around noting the patient’s sex in the corresponding field on the claim form.

If you are submitting a professional or institutional claim electronically — which Harvard Pilgrim recommends for its ease of use and quicker turnaround times — for a member who identifies as non-binary, report “U” in the applicable demographic element. It’s important to note that leaving this demographic element blank would result in an up-front rejection of your claim.

For paper claims, when submitting a CMS-1500 professional claim form, leave the sex field blank (indicated in Box 3). When submitting a paper UB-04 institutional claim form, enter “U” in Box 11, which indicates the patient’s sex. As with electronic claims, it’s important not to leave the field indicating the patient’s sex (Box 11) blank or the claim will reject.

For more information about submitting claims electronically, as well as guidance on the many other convenient tools and functionality offered electronically by Harvard Pilgrim, visit the Electronic Tools and HPHConnect section of our provider website. You can learn more about paper claims submission in the Completing a Paper CMS-1500 (02-12) Form and Completing a Paper UB-04 Form policies in the Billing and Reimbursement section of Harvard Pilgrim’s commercial online Provider Manual.


Publication Information

Annmarie Dadoly,
Editor

Joseph O’Riordan,
Writer

Kristin Edmonston,
Production Coordinator