Patients name (spelled correctly as it appears on their card)
8-digit number on the Gold Card or either the 10-digit recipient ID number.
Workers Comp Insurance
Employer name, Employers Mailing Address, Employer city, Employer phone number
Major Medical Insurance/Secondary Insurance
Patients relationship to insured (SELF, SPOUSE or CHILD)
Insured's D.O.B. (Insurance Company's will no longer pay without the DOB)
Group name and Group number
Contract (policy) number
Owner of the Vehicle you were in.
Auto Insurance Name, Address, Phone Number.
Policy Number and Claim Number