| Field Description | Field ID |
| Primary Payer Name | @INS1 |
| Primary Policy Group # | @INS1GRP |
| Primary Policy Member ID | @INS1MEM |
| Primary Payer Address 1 | @INS1ADDR |
| Primary Payer Address 2 | @INS1ADDR2 |
| Primary Payer City | @INS1CITY |
| Primary Payer State | @INS1STATE |
| Primary Payer Zip | @INS1ZIP |
| Primary Payer Phone | @INS1PH |
| Primary Payer Copay | @PCOP |
| Primary Policy Co-Insurance | @PCOINS |
| Primary Patient Deductible | @PDEDUCT |