837I Other Subscriber Data Section

Populate the associated loops in the 837I file.

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1. In the Other Insured Group Name (SBR-04) table, click Add.

2. Enter information as appropriate.

• If the remaining fields in this section are blank, and there is associated data in the Funding Source/Contracting Provider Reporting Defaults form (837 Institutional section), that data is included in this form.