SBR

Subscriber Information

Pos: 005	Max: 1
Detail - Optional
Loop: 2000B	Elements: 5

Ref

Id

Element Name

Req

Type

Min/Max

Usage

SBR01

1138

Payer Responsibility Sequence Number Code
Description: Code identifying the insurance carrier's level of responsibility for a payment of a claim
UB-92 Ref. [UB-Name]: 50 (A-C) [Payer Identification]
51 (A-C) [Provider Number]
52 (A-C) [Release of Information Certification Indicator]
53 (A-C) [Assignment of Benefits Certification Indicator]
54 (A-C) [Prior Payments - Payers and Patient]
55 (A-C) [Estimated Amount Due]
58 (A-C) [Insured’s Name]
59 (A-C) [Patient’s Relationship to Insured]
60 (A-C) [Certificate/Social Security Number/Health Insurance Claim/ Identification Number]
61 (A-C) [Insured Group Name]
62 (A-C) [Insurance Group Number]
63 (A-C) [Treatment Authorization Code]
64 (A-C) [Employment Status Code of the Insured]
65 (A-C) [Employer Name of the Insured]
66 (A-C) [Employer Location of the Insured]
EMC v.6.0 Reference: Record Type 30 Field No. 2 (Sequence 01-03)
Record Type 31 Field No. 2 (Sequence 01-03)
Record Type 32 Field No. 2 (Sequence 01-03)
Record Type 40 Field No. 5, 6, 7

M

ID

1/1

Required

Code

Name

P

Primary

S

Secondary

T

Tertiary

Use to indicate ’payer of last resort’.

SBR02

1069

Individual Relationship Code
Description: Code indicating the relationship between two individuals or entities
Alias: Patients Relationship to Insured
UB-92 Ref. [UB-Name]: 59 (A-C) [Patient’s Relationship to Insured]
EMC v.6.0 Reference: Record Type 30 Field No. 18
Use this code only when the subscriber is the same person as the patient. If the subscriber is not the same person as the patient, do not use this element.

O

ID

2/2

Situational

Code

Name

18

Self

SBR03

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
Alias: Group Number
UB-92 Ref. [UB-Name]: 62 (A-C) [Insurance Group Number]
EMC v.6.0 Reference: Record Type 30 Field No. 10 (Sequence 01-03)
Use this element to carry the subscriber’s group number but not the number that uniquely identifies the subscriber. The subscriber’s number should be carried in NM109. Using code IL in NM101 identifies the number in NM109 as the insured’s Identification Number.

O

AN

1/30

Situational

SBR04

93

Name
Description: Free-form name
Industry: Insured Group Name
Alias: Plan Name (Group Name)
UB-92 Ref. [UB-Name]: 61 (A-C) [Insured Group Name]
EMC v.6.0 Reference: Record Type 30 Field No. 11 (Sequence 01-03)
Used only when no group number is reported in SBR03.

O

AN

1/60

Situational

SBR09

1032

Claim Filing Indicator Code
Description: Code identifying type of claim
EMC v.6.0 Reference: Record Type 30 Field No. 4 (not all codes map)
Required prior to mandated used of PlanID. Not used after PlanID is mandated.

O

ID

1/2

Situational

Code

Name

09

Self-pay

EMC v.6.0 Reference:

Record Type 30 Field No. 4 Code A

10

Central Certification

11

Other Non-Federal Programs

12

Preferred Provider Organization (PPO)

Same as the qualifier used in CLP06 of the 835 Health Care Claim Payment

13

Point of Service (POS)

Same as the qualifier used in CLP06 of the 835 Health Care Claim Payment

14

Exclusive Provider Organization (EPO)

Same as the qualifier used in CLP06 of the 835 Health Care Claim Payment

15

Indemnity Insurance

16

Health Maintenance Organization (HMO) Medicare Risk

AM

Automobile Medical

Same as the qualifier used in CLP06 of the 835 Health Care Claim Payment

BL

Blue Cross/Blue Shield

EMC v.6.0 Reference:

Record Type 30 Field No. 4 Code G

CH

Champus

EMC v.6.0 Reference:

Record Type 30 Field No. 4 Code H

CI

Commercial Insurance Co.

EMC v.6.0 Reference:

Record Type 30 Field No. 4 Code F

DS

Disability

Same as the qualifier used in CLP06 of the 835 Health Care Claim Payment

HM

Health Maintenance Organization

There is no map to EMC v.6.0. (Same as the qualifier used in CLP06 of the 835 Health Care Claim Payment)

LI

Liability

LM

Liability Medical

Same as the qualifier used in CLP06 of the 835 Health Care Claim Payment

MA

Medicare Part A

EMC v.6.0 Reference:

Record Type 30 Field No. 4 Code C (Same as the qualifier used in CLP06 of 835 Health Care Claim Payment)

MB

Medicare Part B

Same as the qualifier used in CLP06 of the 835 Health Care Claim Payment

MC

Medicaid

EMC v.6.0 Reference:

Record Type 30 Field No. 4 Code D

OF

Other Federal Program

EMC v.6.0 Reference:

Record Type 30 Field No. 4 Code E

TV

Title V

Same as the qualifier used in CLP06 of the 835 Health Care Claim Payment

VA

Veteran Administration Plan

Same as the qualifier used in CLP06 of the 835 Health Care Claim Payment. Refers to Veterans Affairs Plan.

WC

Workers' Compensation Health Claim

EMC v.6.0 Reference:

Record Type 30 Field No. 4 Code B (Same as the qualifier used in CLP06 of 835 Health Care Claim Payment)

ZZ

Mutually Defined

Unknown Required value if the HIPAA Individual Identifier is mandated for use. Otherwise, the MI qualifier is used.

1.

SBR02 specifies the relationship to the person insured.

2.

SBR03 is policy or group number.

3.

SBR04 is plan name.

4.

SBR07 is destination payer code. A "Y" value indicates the payer is the destination payer; an "N" value indicates the payer is not the destination payer.

Example:

SBR*P**GRP01020102******CI~