SBR

Subscriber Information

Pos: 005	Max: 1
Detail - Optional
Loop: 2000B	Elements: 6

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

M

ID

1/1

Required

Code

Name

P

Primary

NSF Reference:

DA0-02.0-Pri

S

Secondary

NSF Reference:

DA1-02.0-Sec

T

Tertiary

Use to indicate payer of last resort.

SBR02

1069

Individual Relationship Code
Description: Code indicating the relationship between two individuals or entities
NSF Reference: DA0-17.0
Required 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
NSF Reference: DA0-10.0
Required if the subscriber’s payer identification includes Group or Plan Number. This data element is intended to carry the subscriber’s Group Number, not the number that uniquely identifies the subscriber (Subscriber ID, Loop 2010BA-NM109).

O

AN

1/30

Situational

SBR04

93

Name
Description: Free-form name
Industry: Insured Group Name
Alias: Plan Name
NSF Reference: DA0-11.0
Required if the Subscriber’s payer identification includes Plan Name.

O

AN

1/60

Situational

SBR06

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

6

No Coordination of Benefits

SBR09

1032

Claim Filing Indicator Code
Description: Code identifying type of claim
Required prior to mandated use of PlanID. Not used after PlanID is mandated.

O

ID

1/2

Situational

Code

Name

09

Self-pay

NSF Reference:

DA0-05.0 (A)

11

Other Non-Federal Programs

Should be used to indicate that the subscriber is enrolled in a state program.

12

Preferred Provider Organization (PPO)

13

Point of Service (POS)

14

Exclusive Provider Organization (EPO)

15

Indemnity Insurance

16

Health Maintenance Organization (HMO) Medicare Risk

17

Dental Maintenance Organization

BL

Blue Cross/Blue Shield

NSF Reference:

CA0-23.0 (G), DA0-05.0 (G), CA0-23.0 (P), DA0-05.0 (P)

CH

Champus

NSF Reference:

CA0-23.0 (H), DAO-05.0 (H)

CI

Commercial Insurance Co.

NSF Reference:

CA0-23.0 (F), DA0-05.0 (F)

DS

Disability

FI

Federal Employees Program

NSF Reference:

CA0-23.0 (J), DA0-05.0 (J)

HM

Health Maintenance Organization

NSF Reference:

CA0-23.0 (I), DA0-05.0 (I)

LM

Liability Medical

MB

Medicare Part B

NSF Reference:

CA0-23.0 (C), DA0-05.0 (C)

MC

Medicaid

NSF Reference:

CA0-23.0 (D), DA0-05.0 (D)

MH

Managed Care Non-HMO

NSF Reference:

DA0-05.0 (N)

OF

Other Federal Program

NSF Reference:

CA0-23.0 (E), DA0-05.0 (E)

SA

Self-administered Group

NSF Reference:

CA0-23.0 (E), DA0-05.0 (E)

VA

Veteran Administration Plan

NSF Reference:

DA0-05.0 (V)

WC

Workers' Compensation Health Claim

NSF Reference:

CA0-23.0 (Z), DA0-05.0 (Z)

ZZ

Mutually Defined

Unknown

NSF Reference:

CA0-23.0 (Z), DA0-05.0 (Z)

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***6***CI~