If block 13 is left blank when submitting a claim, what is the expected outcome?

If block 13 is left blank when submitting a claim, what is the expected outcome?

• A. The third party payer reimburses the patient and the patient is responsible for reimbursing the provider
• B. The payer reimburses the provider directly
• C. The claim is rejected
• D. The patient is billed only after payer pays

Answer: (A)

Block 13 indicates whether the patient has assigned benefits to the provider. When this field is left blank, there is no assignment on file. Without an assignment, the insurer processes and pays the claim to the patient rather than directly to the provider. The patient then has the responsibility to reconcile or reimburse the provider for services rendered. That’s why the outcome described—payment going to the patient and the patient paying the provider—best fits leaving that block blank. If the patient had signed an assignment of benefits, the payer would typically reimburse the provider directly. The other scenarios—payment being rejected or the patient only being billed after the payer pays—don’t reflect the plain effect of leaving the assignment block empty.

Block 13 indicates whether the patient has assigned benefits to the provider. When this field is left blank, there is no assignment on file. Without an assignment, the insurer processes and pays the claim to the patient rather than directly to the provider. The patient then has the responsibility to reconcile or reimburse the provider for services rendered. That’s why the outcome described—payment going to the patient and the patient paying the provider—best fits leaving that block blank.

If the patient had signed an assignment of benefits, the payer would typically reimburse the provider directly. The other scenarios—payment being rejected or the patient only being billed after the payer pays—don’t reflect the plain effect of leaving the assignment block empty.