Beneficiary Signature Requirements

Beneficiary signatures are required on submitted claims in item 12 of the CMS-1500 claim form. In lieu of signing the claim, the patient may sign a statement or authorization form to be retained in the provider’s file indefinitely, unless revoked by the patient. The provider can then submit “signature on file” in item 12.

For electronic claims submitted in ANSI 4010A1 format, submitters/providers must enter one of the following values in Loop 2300 2-130- CLM10:

• B – Signed signature authorization form or forms for both CMS-1500 Claim Form item 12 and item 13 are on file
• C – Signed CMS-1500 Claim Form on file
• M – Signed signature authorization form for CMS-1500 Claim Form item 13 on file
• P – Signature generated by provider because the patient was not physically present for services
• S – Signed signature authorization form for CMS-1500 Claim Form item 12 on file