COB

Coordination of Benefits

Pos: 400	Max: 1
Detail - Optional
Loop: 2320	Elements: 3

Ref

Id

Element Name

Req

Type

Min/Max

Usage

COB01

1138

Payer Responsibility Sequence Number Code
Description: Code identifying the insurance carrier's level of responsibility for a payment of a claim

O

ID

1/1

Required

Code

Name

P

Primary

S

Secondary

T

Tertiary

U

Unknown

COB02

127

Reference Identification
Description: Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
Industry: Insured Group or Policy Number
Always supply the policy number when it is available.

O

AN

1/30

Situational

COB03

1143

Coordination of Benefits Code
Description: Code identifying whether there is a coordination of benefits

O

ID

1/1

Required

Code

Name

1

Coordination of Benefits

5

Unknown

6

No Coordination of Benefits

Use this code to verify that it was determined that there is no COB.

1.

COB02 is the policy number.

Notes:

1. Use this loop whenever an individual has another insurance plan with benefits similar to those covered by the insurance product specified in the HD segment for this occurrence of Loop ID-2300. Always provide this information when provided to the sponsor. Provide the COB information by individual, not by subscriber.
2. Send this data when such transmission is required under the insurance contract between the sponsor and the payer.

Example:

COB*P*XYZ123*1~