UB04 Field 65: Employer Name

Overview

Field 65 (Employer Name) on the UB-04 claim form captures the name of the employer that provides health care coverage for the insured individual. This field is designated as Situational by CMS, meaning it is not required for all claims but must be completed under specific circumstances ^[1]. The employer name entered here must correspond to the individual identified on the same line in Field 58 (Insured’s Name) ^[1]. This field is part of the payer information section and helps identify the responsible party for coordination of benefits, particularly when workers’ compensation (WC) or employer group health plans (EGHP) are involved ^[1].

When to Use

Field 65 must be completed when the provider is claiming payment under circumstances described in the second paragraph of Fields 58A, 58B, or 58C and there is workers’ compensation involvement or an employer group health plan (EGHP) ^[1]. Specifically, this field is situational and applies only when the insured’s coverage is through an employer-sponsored plan or when workers’ compensation benefits are primary ^[2]. For example, if a patient is covered under a spouse’s employer-sponsored health plan and the claim involves a work-related injury, the employer name must be entered in this field. Providers should verify payer-specific requirements, as some state Medicaid programs may have additional instructions regarding when this field is necessary.

Step-by-Step Claim Example

Scenario: A patient is treated for a work-related injury. The patient’s primary coverage is through their employer’s group health plan (EGHP), and workers’ compensation is secondary.

1. Identify the insured: In Field 58, enter the patient’s name as the insured individual (e.g., “John Doe”).
2. Determine employer involvement: Since the claim involves workers’ compensation and an EGHP, Field 65 is required.
3. Enter employer name: In Field 65, enter the name of the employer that provides the health care coverage for the insured (e.g., “ABC Manufacturing Company”).
4. Cross-reference with Field 58: Ensure the employer name corresponds to the same line in Field 58 where the insured’s name appears.
5. Complete other fields: Fill in Fields 50 (Payer Name), 51 (Health Plan ID), 58 (Insured’s Name), 59 (Patient Relationship), 60 (Insured’s Unique ID), 61 (Insured’s Group Name), and 62 (Insured’s Group Number) as applicable.
6. Submit claim: The completed Field 65 will help the payer coordinate benefits between the EGHP and workers’ compensation.

Common Mistakes & Audit Red Flags

• Leaving field blank when required: Failing to enter the employer name when workers’ compensation or EGHP is involved can result in claim denial or delayed payment ^[1].
• Entering incorrect employer name: The employer name must match the name on the insured’s health plan documentation. Mismatches can trigger coordination of benefits errors.
• Using field for non-EGHP claims: Entering an employer name when no EGHP or workers’ compensation is involved may confuse payers and cause unnecessary claim edits.
• Inconsistent data with Field 58: The employer name must correspond to the insured listed on the same line in Field 58. If multiple insured individuals are listed, each line must have the correct employer name.
• Omitting field for workers’ compensation claims: Even if the employer is the same as the workers’ compensation carrier, the employer name must still be entered in Field 65.
• Audit red flags: Payers may flag claims where Field 65 is completed but Fields 61 (Insured’s Group Name) or 62 (Insured’s Group Number) are missing, as this suggests incomplete coordination of benefits data.

Related Codes/Fields

Field Number	Field Name	Relationship to Field 65
FL 58	Insured’s Name	Employer name must correspond to the insured on the same line
FL 59	Patient Relationship to Insured	Identifies if patient is employee, spouse, or dependent
FL 60	Insured’s Unique ID	Links insured to employer-sponsored plan
FL 61	Insured’s Group Name	Often matches or relates to employer name
FL 62	Insured’s Group Number	Identifies the specific employer group plan
FL 50	Payer Name	Identifies the payer processing the claim
FL 51	Health Plan Identification Number	Links to employer’s health plan contract
FL 63	Treatment Authorization Code	May be required for workers’ compensation claims
FL 64	Document Control Number (DCN)	Used for tracking claims with employer involvement

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References

[1] CMS Chapter 25 — FL 65 — https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/clm104c25.pdf

[2] CMS R1915CP — https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R1915CP.pdf