Third Party || Requirements

Requirements

Name

Insurance Cardholder Expiration Date

Patient Residence

Relationship to Cardholder

Group No

Patient Person Code

Patient Subscriber No

Search Criteria

Third Party

BIN

Plan Name	BIN	Payer	PCN
CA CMC	610144	CA CMC	DOCER
CMS 1500 Claim Form	610785	CCMS 1500 Claim Form(2012)	ERCLCERT
Eligibility Commercial Plan	610785	Commercial Plan	COMMCF
Eligibility Medicare Plan	610785	Medicare Plan	COMMCF