UB04 Field 59: Patient's Relation to Insured

Overview

Field 59 on the UB‑04 claim form is labeled Patient Relationship to Insured as listed in the Maryland Medicaid UB04 Hospital Billing Instructions ^[1]. This field is used to indicate the relationship of the patient to the person named as the insured (the subscriber). The Maryland Medicaid document places this field between FL 58 (Insured’s Name) and FL 60 (Insured’s Unique ID) ^[1]. The field is part of the payer information block where the subscriber’s identity and benefit details are captured. The exact code set and format are defined by the National Uniform Billing Committee (NUBC) standards; however, the provided source only confirms the field’s title and position. Because the field appears in the UB‑04 form’s “Payer Name” section sequence, it is critical for linking the patient to the correct insurance subscriber. Use of this field helps payers determine the correct coordination of benefits and apply the appropriate patient liability. In the Maryland instruction, the field is listed among mandatory or conditional data elements, depending on payer requirements ^[1]. The source does not provide specific relationship codes, so providers must refer to the NUBC manual or individual payer contract guidelines for valid values. Overall, FL 59 ensures that the claim accurately reflects who the patient is relative to the insured subscriber.

When to Use

Field 59 must be completed whenever the patient is not the same person as the insured subscriber. The Maryland Medicaid UB04 instructions list this field as part of the standard claim form layout, implying it is required for all claims where subscriber information is present ^[1]. For inpatient and outpatient claims filed to Medicaid or commercial payers, the field is “If Applicable” per the user’s instruction, meaning it should be populated when the patient has a relationship other than “self.” However, the source does not clarify specific payer rules; therefore, providers should follow the guidance of the primary payer. When the patient is the insured, the relationship code is typically “18” (Self) per NUBC standards, but the Maryland source does not enumerate codes. The field is essential for coordination of benefits: if the patient is a spouse or child, the relationship triggers correct claims adjudication. Without a populated relationship code, the claim may be rejected or incorrectly processed. In the Maryland document, FL 59 is positioned among other subscriber‑related fields (FL 58, FL 60–62), underscoring its role in completing the insured’s identification block ^[1]. Therefore, use this field on every UB‑04 claim where the patient’s relationship to the insured is not self-evident, or as directed by payer instructions.

Step-by-Step Claim Example

The following step-by-step example illustrates how to complete Field 59 using the Maryland Medicaid UB04 instructions as a reference. The source confirms the field name and its placement after FL 58 and before FL 60 ^[1]. Assume a patient named Sarah Jones receives inpatient services. Sarah is the spouse of John Jones, who is the insured under a health plan. The billing clerk first enters the insured’s name (John Jones) in FL 58. Next, in FL 59, the clerk must indicate Sarah’s relationship to John. Although the source does not list code values, standard NUBC codes include “01” for spouse. The clerk enters “01” in the two-digit field. Following FL 59, the clerk populates FL 60 (Insured’s Unique ID) with John’s membership number, and FL 61 (Insured’s Group Name) with the employer name as shown in the Maryland instruction’s sequence ^[1]. For a child patient, the relationship code would be “19.” The source does not specify the field length, but the UB‑04 standard uses two numeric digits. After entering the relationship, the clerk reviews the payer block (FL 50–FL 66) for consistency. The completed claim then accurately reflects the patient‑insured link. This example follows the field order provided by Maryland Medicaid and ensures the claim meets basic payer requirements.

Common Mistakes & Audit Red Flags

The Maryland Medicaid UB04 instructions only list Field 59 by name and do not detail errors, but common audit concerns can be inferred from the field’s purpose and the surrounding fields ^[1]. A frequent mistake is leaving FL 59 blank when the patient is not the insured. Payers may reject the claim or apply incorrect patient liability. Another red flag is using an invalid or unapproved relationship code. Since the source does not provide valid codes, providers must rely on the NUBC manual; using codes outside the standard set can trigger audits. Inconsistent data across fields also invites scrutiny: for example, if FL 58 shows a different last name than the patient in FL 60’s ID, but FL 59 indicates “self” (patient equals insured), the mismatch is a clear error. Additionally, entering a relationship code that does not match the subscriber’s age or family composition (e.g., “spouse” for a minor child) may seem suspicious. The Maryland document lists FL 59 immediately after FL 58 (Insured’s Name) and before FL 60 (Insured’s Unique ID), so a missing or garbled relationship code can break the logical sequence of subscriber data ^[1]. Audit reviewers often cross‑check FL 59 with patient demographic records to verify the relationship. To avoid issues, always populate FL 59 if the patient is not the insured, use only NUBC‑approved codes, and ensure consistency with the name and ID in adjacent fields.

Related Codes/Fields

The Maryland Medicaid UB04 instructions list Field 59 in sequence with several payer‑related fields that are directly relevant. The table below shows the fields that surround FL 59 and their relationship to the patient‑insured link.

Field Number	Field Name	Relationship to FL 59	Source Reference
FL 58	Insured’s Name	Provides the name of the insured person against whom the relationship is stated.	[1]

| FL 59 | Patient Relationship to Insured | The subject field; contains the relationship code (e.g., self, spouse, child). | [Maryland Medicaid — FL

---

References

[1] Maryland Medicaid — FL 59 — https://health.maryland.gov/mmcp/provider/Documents/ffs-billing/UB04-Hospital-Billing-Instructions%20%281%29.pdf