Wednesday, 1 August 2012

EDI 5010 Documentation 837 Professional - Loop 2320 Other Subscriber Information

2320  Other Subscriber Information

        

This loop is required only if current insurance sequence > 1. i.e. for secondary, tertiary, etc.

Say for example, if the current insurance is secondary, then we should run this loop for the primary insurance. If the current insurance is tertiary, then we should run this loop for the primary and then secondary insurance. And also so on. In general, take the sequence number of the current insurance, and run this loop for all the previous sequence insurance.

 
2320 Other  Subscriber Information
Loop Seg ID Segment Name Format Length Ref# Req Value
2320 SBR Subscriber Information ID 3 R SBR
Element Separator AN 1 *
SBR01 Payer Responsibility Code ID 1/1 1138 R See below for more information
Element Separator AN 1 *
SBR02 Individual Relationship code ID 2/2 1069 S If Subscriber is same person as of the patient, then Print 18, else do not print , just append element separator.
Element Separator AN 1 *
SBR03 Reference Identification AN 1/50 127 S Print Patient –> Insurance –> Group Number
Element Separator AN 1 *
SBR04 Name AN 1/60 93 S Print Patient-> Insurance-> Group Name
Element Separator AN 1 *
SBR05 Insurance Type Code ID 1/3 1336 S See below for more information
Element Separator AN 1 *
SBR06 Coordination of Benefit code Not Used *
SBR07 Yes/No Condition Not Used *
SBR08 Employment Status Code Not Used *
SBR09 Claim filling Indicator Code ID 1/2 1032 S See below for more information
Segment Terminator ~
               

SBR01 – Payer Responsibility Sequence Number Code
Code Definition
P Primary
S Secondary
T Tertiary
A Code for the 4th Insurance
B Code for the 5th Insurance
C Code for the 6th Insurance
D Code for the 7th Insurance
E Code for the 8th Insurance
F Code for the 9th Insurance
G Code for the 10th Insurance
H Code for the 11th Insurance
SBR05 – Insurance Type Code
2000B SBR05 is required when Medicare is the destination payer but not the primary payer i.e Medicare would be the second or third payer. We should capture this field either in the Patient Insurance Policy information or at the claim level.

Code Definition
12 Medicare Secondary Working Aged Beneficiary or Spouse with Employer Group Health Plan
13 Medicare Secondary End Stage Renal Disease
14 Medicare Secondary , No Fault Insurance including Auto is Primary
15 Medicare Secondary Worker’s Compensation
16 Medicare Secondary Public Health Service (PHS) or other Federal Agency
16 Medicare Secondary Public Health Service
41 Medicare Secondary Black Lung
42 Medicare Secondary Veteran’s Administration
43 Medicare Secondary Veteran’s Administration
47 Medicare Secondary, Other Liability Insurance is Primary



SBR09 – Claim Filling indicator code

We should capture this field (single selection drop down) in the insurance master screen for each insurance.
Code Definition
11 Other Non-Federal Programs
12 Preferred Provider Organizations
13 Point of Service
14 Exclusive Provider Organization
15 Indemnity Insurance
16 Health Maintenance Organization (HMO) Medicare Risk
17 Dental Maintenance Organization
AM Automobile Medical
BL Blue Cross/Blue Shield
CH Champus
CI Commercial Insurance Co
DS Disability
HM Health Maintenance Organization
LM Liability Medical
MB Medicare Part B
MC Medicaid
MA Medicare Part A
OF Other Federal Program
TV Title V
VA Veteran Administration Plan
WC Worker’s Compensation Health Claim
FI Federal Employees Program
ZZ Mutually Defined.
 
 
2320 Coordination of Benefits (COB) Payer Paid Amount
Loop Seg ID Segment Name Format Length Ref# Req Value
2320 AMT Payer Paid Amount ID 3 R AMT
Element Separator AN 1 *
AMT01 Amount Qualifier Code ID 1/3 522 R D = Payer Amount Paid
Element Separator AN 1 *
AMT02 Monetary Amount ID 1/18 782 R Print the Paid Amount
Segment Terminator ~
 

 
 
2320 Other Insurance Coverage Information.
Loop Seg ID Segment Name Format Length Ref# Req Value
2320 OI Other Insurance Coverage ID 2 s OI
Element Separator AN 1 *
OI01 Claim Filling Indicator Code ID 1/2 1032 Not Used  
Element Separator AN 1 *
OI02 Claim Submission Reason Code ID 2/2 1383 Not Used  
Element Separator AN 1 *
OI03 Yes/No Assignments of Benefit ID 1/1 1073 R Y
Element Separator AN 1 *
OI04 Patient Signature Source Code ID 1/1 1351 R B
Element Separator AN 1 *
OI05 Provider Agreement Code ID 1/1 1360 Not Used  
Element Separator AN 1 *
OI06 Yes/No Release of Information Code ID 1/1 1363 R Y
    Segment Terminator         ~

 

Example.

SBR*P*18*******CI
AMT*D*52.01
OI***Y***Y

 

For complete Example, please refer to use case 9 in the Home page

 
        

Questions or feedback are always welcome. You can email me at vbsenthilinnet@gmail.com. 

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