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