2000B Subscriber Hierarchical Level
For this Loop, Take the information from Patient Insurance and Insurance Master details.
| Loop | Seg ID | Segment Name | Format | Length | Ref# | Req | Value |
| 2000B | HL | Subscriber Hierarchical Level | ID | 2 | R | HL | |
| Element Separator | AN | 1 | * | ||||
| HL01 | Subscriber ID Number | AN | 1/12 | 628 | R | 2 | |
| Element Separator | AN | 1 | * | ||||
| HL02 | Hierarchical Parent ID Number | AN | 1/12 | 734 | R | 1 | |
| Element Separator | AN | 1 | * | ||||
| HL03 | Hierarchical Level Code | ID | 1/2 | 735 | R | 22 | |
| Element Separator | AN | 1 | * | ||||
| HL04 | Hierarchical Child Code | ID | 1/1 | 736 | R | 0 | |
| Segment Terminator | ~ | ||||||
2000B Subscriber Information
| Loop | Seg ID | Segment Name | Format | Length | Ref# | Req | Value |
| 2000B | 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. |
2000B Subscriber Information – Sample
Test data - Use case 1:
Insurance Master Setup
| Field | Value |
| Insurance Name | Cigna |
| Insurance Program | ZZ (Mutually Defined). Drop down. Values should be from this list |
Test data – Patient Insurance Policy Setup
| Field | Value |
| Insurance Plan | Cigna Prim Plan |
| Patient Relation | Self |
| Group Name | XYZ |
| Group Number | 492929 |
Destination payer is Cigna and patient is same as the subscriber.
SBR*P*18*492929*XYZ*****ZZ~
****************************************************************************************************************
Test data - Use case 2:
Insurance Master Setup
| Field | Value |
| Insurance Name | Medicare |
| Insurance Program | MB ( Medicare Part B). Drop down. Values should be from this list |
Test data – Patient Insurance Policy Setup
| Field | Value |
| Insurance Plan | Medicare Plan |
| Patient Relation | Child |
| Group Name | Premium Plus |
| Group Number | ABC34F3 |
Destination payer is Medicare and patient is NOT same as the subscriber.
SBR*P**ABC34F3*Premium Plus*****MB~
Test data - Use case 3:
Insurance Master Setup
| Field | Value |
| Insurance Name | Medicare |
| Insurance Program | MB ( Medicare Part B). Drop down. Values should be from this list |
Test data – Patient Insurance Policy Setup
| Field | Value |
| Insurance Plan | Medicare Plan |
| Patient Relation | Child |
| Group Name | Premium Plus |
| Group Number | ABC34F3 |
| Secondary Type | 41 Drop down. Values should be from this list . |
Destination payer is Medicare WHICH IS AT THE 5TH Level and patient is NOT same as the subscriber.
SBR*B**ABC34F3*Premium Plus*41****MB~