Indicating Assignment on the Claim Form

A short definition of assignment is, “who gets the money | insurance check | EOB.”

The insured is the beneficiary of the insurance. In order for you to receive the insurance payment from the insurance company, you need permission from the insured (or other authorized person usually the spouse or parent).

Accepting Assignment

The insured could be asked to sign each claim form in block 13 but the usual process is for the doctor to get a ‘NOTICE OF ASSIGNMENT’ signed then print ‘SIGNATURE ON FILE’ in block 13. A ‘notice of assignment’ is only considered to be good for one year.

Assignment is indicated on the claim form primarily in two places:

  • Block 13 with ‘SIGNATURE ON FILE’
  • Block 27 checked “YES”.

Sometimes, ‘signature on file’ in block 13 by itself will trigger assignment even if block 27 is checked ‘NO’.

Claim Form Indicating Assignment

Not Accepting Assignment

If you don’t want to accept assignment:

  • Leave block 13 blank OR put ‘NO ASSIGNMENT’ in block 13 (the current trend seems to be the ‘no assignment’ option).

Chiropractic Claims


  • Check ‘NO’ in block 27

provider NPI

  • Show the patient payment in block 29 when required

At some insurance companies the amount that the patient paid must be shown in block 29 to indicate that assignment is not being accepted. Otherwise, assignment can be inadvertently triggered.

This happens when the patient is required to pay a certain amount on each visit. The insurance company wants to you to verify that the patient is meeting their policy obligations and that the doctor is not forgiving this amount. This may be true for your Medicare carrier. (see block 29 in the example claim above)

[In the FormSmith Program: you can turn on printing of the patient paid amount by insurance company – File | Insurance Companies | (edit insurance company) | go to the Form Completion Tab | check ‘show patient payment in block 29’]