UB04 Condition Codes Code 08: Beneficiary Would Not Provide Information Concerning Other Insurance Coverage

Overview

Condition Code 08 on the UB-04 claim form indicates that the beneficiary actively refused to provide information concerning other insurance coverage at the time of service or during the billing process. This code is used exclusively when the patient or their representative declines to disclose details about any primary or secondary health insurance policies they may have, leaving the provider unable to coordinate benefits or verify a payer hierarchy. According to the Noridian condition code list, code 08 is defined exactly as “Beneficiary would not provide information concerning other insurance coverage.” ^[1] The code is entered in Field 18–28 (Condition Codes) of the UB-04 form, which is a 2‑character alphanumeric field that can hold up to eight codes. The MassHealth UB‑04 Billing Guide confirms that condition codes are part of the standard code sets used on the UB‑04 and that providers must complete the form in accordance with payer‑specific instructions. ^[2] Because the provider cannot determine whether other insurance exists, applying code 08 signals to the payer that the claim may need to be processed as primary if no other coverage is later identified, or that secondary payer edits may be bypassed based on the patient’s refusal. This code is distinct from code 03 (“Patient is covered by an insurance not reflected here”), which is used when the patient acknowledges coverage but the policy details are unknown or omitted by the provider. Code 08 places the onus on the beneficiary for the lack of coordination and may affect claim payment timing or the provider’s ability to recover amounts that should have been paid by another insurer.

When to Use

Condition Code 08 should be applied only when the provider has made a reasonable effort to ask the beneficiary about any other health insurance coverage and the beneficiary explicitly refuses to provide that information. This refusal can occur verbally or in writing, and it is best practice to document the refusal in the patient’s financial or medical record. The code is most commonly used in settings where coordination of benefits is critical, such as acute inpatient hospitals, outpatient departments, or skilled nursing facilities, because delaying or omitting other coverage information can lead to inaccurate primary payer assignments. ^[1] The MassHealth Billing Guide provides extensive third‑party liability (TPL) instructions, noting that providers are expected to collect and report all available insurance information for MassHealth members; however, if a member refuses, the provider should still submit the claim and may use an appropriate condition code to explain the situation. ^[2] (See Appendix A for TPL supplemental instructions.) Importantly, code 08 should not be used simply because the provider failed to ask or because the patient was unresponsive to routine billing inquiries. It requires a deliberate refusal. If the patient does not know or is unable to provide information (e.g., dementia, minor child with absent parent), code 08 is not appropriate; instead, the provider should consider code 03 (“Patient is covered by an insurance not reflected here”) or other relevant codes. Using code 08 may trigger an additional review by the payer to confirm that the provider attempted to obtain the information. Medicare contractors, for example, may deny the claim if they later discover other coverage existed, unless the refusal is well documented. Therefore, this code should be used sparingly and only with supporting documentation.

Step-by-Step Claim Example

Scenario: A 72‑year‑old Medicare beneficiary is admitted to an acute care hospital for a hip replacement. During registration, the admissions clerk asks the patient if he has any other health insurance (e.g., employer group health plan, supplemental policy, or Medicaid). The patient responds, “That’s none of your business. Just bill Medicare.” The clerk notes the refusal in the patient’s account and places a flag for billing.

Step 1: Identify the correct condition code. Because the beneficiary refused to provide any other insurance information, the billing staff selects Condition Code 08. ^[1]

Step 2: Complete the UB‑04 claim form. Following the MassHealth UB‑04 guide for field placement: enter “08” in one of the eight available slots in Field 18–28 (Condition Codes). Field 18 is the first condition code field on the form. If other condition codes apply (e.g., code 01 for military service), code 08 can be placed in any available slot, but it is common to list it first when it is the primary reason for coordination issues. ^[2]

Step 3: Complete other required fields. In Field 50‑66 (Payer Identification), list Medicare as the primary payer (e.g., Part A for inpatient). Do not list any other payer since no information was provided. In Field 39‑41 (Value Codes and Amounts), use value code 12 (Working aged beneficiary/employer group health plan) only if the provider has some indication of other coverage; otherwise, leave blank. Since the patient refused, no value code for other insurance is appropriate.

Step 4: Attach documentation (if required by payer). Some payers accept code 08 on the UB‑04 without supporting documentation, but it is prudent to include an internal note or a separately submitted remark. The MassHealth TPL appendix suggests that when a member refuses, the provider should note the reason on the claim or in an attachment. ^[2]

Step 5: Submit the claim. Send the UB‑04 to Medicare (or the appropriate primary payer). The payer will process the claim as if no other insurance exists, based on the patient’s refusal. If the patient later contacts the provider with insurance details, the provider should correct the claim using a replacement claim and remove code 08.

Common Mistakes & Audit Red Flags

1. Using code 08 when the patient simply does not know or cannot provide information. The code explicitly requires a refusal, not ignorance or incapacity. Misuse may be flagged during post‑payment review, and the provider may be asked to refund payments if other coverage is later discovered. ^[1]

2. Failing to document the refusal. Without clear documentation (e.g., signed refusal form, notes in the patient record), auditors may assume the provider did not attempt to collect the information. The MassHealth Billing Guide emphasizes the importance of documenting TPL efforts. ^[2]

3. Using code 08 alongside other condition codes that contradict it. For example, coding both 08 and 03 (“Patient is covered by an insurance not reflected here”) is logically inconsistent—the patient either refused or acknowledged other coverage. Auditors will question such combinations.

4. Omitting required value codes when information is available. If the provider later obtains information about other insurance (e.g., a Medicare Secondary Payer questionnaire reveals employer coverage), code 08 should no longer be used. Failure to update the claim can result in overpayment or denial.

5. Applying code 08 to all Medicare beneficiaries as a default. Some providers incorrectly use this code when they assume the patient has supplemental coverage but did not ask. This is a red flag for systemic abuse and may lead to extrapolated audits. Always obtain an actual refusal.

6. Not coordinating with other insurance when the payer later asks for it. Even if code 08 is submitted, the payer may request additional information. Ignoring such requests can result in recoupment. Providers should have a process to follow up on refused information.

Related Codes/Fields

The table below lists related condition codes that address other insurance situations and the relevant UB‑04 fields where coverage information is reported.

Code / Field	Description	Source
Condition Code 03	Patient is covered by an insurance not reflected here	[1]
Condition Code 09	Neither the patient nor the spouse is employed	[1]
Condition Code 10	Patient and/or spouse is employed but no EGHP coverage exists	[1]
Condition Code 11	Disabled beneficiary but no LGHP	[1]
Condition Code 28	Patient's and/or spouse's EGHP is secondary to Medicare	[1]
Condition Code 29	Disabled beneficiary and/or family members LGHP is secondary to Medicare	[1]
Field 50–66 (Payer Identification)	Used to list the primary, secondary, and tertiary payers	[2]
Field 39–41 (Value Codes)	Used to report amounts related to other coverage (e.g., value code 12 for EGHP)	[2]
Occurrence Code 24 (if applicable)	Used to indicate date insurance refused or declined – see payer specific instructions	Not explicitly in provided sources; check payer manual

Note: Always consult the specific payer’s billing guide (e.g., Medicare, MassHealth) for exact field placement and allowable code combinations. The UB‑04 condition code field (18–28) can contain up to eight codes, and the order may matter for some payers. ^{[1] [2]}

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References

[1] Noridian Condition Codes — https://med.noridianmedicare.com/web/jea/topics/claim-submission/condition-codes

[2] MassHealth UB-04 Guide — https://www.mass.gov/doc/ub-04-billing-guide-0/download