Loop 2320

Pos: 290	Repeat: 10
Optional
Loop: 2320	Elements: N/A

Pos

Id

Segment Name

Req

Max Use

Repeat

Usage

290

SBR

Other Subscriber Information

O

1

Situational

295

CAS

Claim Adjustment

O

5

Situational

300

AMT

Coordination of Benefits (COB) Payer Paid Amount

O

1

Situational

300

AMT

Coordination of Benefits (COB) Approved Amount

O

1

Situational

300

AMT

Coordination of Benefits (COB) Allowed Amount

O

1

Situational

300

AMT

Coordination of Benefits (COB) Patient Responsibility Amount

O

1

Situational

300

AMT

Coordination of Benefits (COB) Covered Amount

O

1

Situational

300

AMT

Coordination of Benefits (COB) Discount Amount

O

1

Situational

300

AMT

Coordination of Benefits (COB) Patient Paid Amount

O

1

Situational

305

DMG

Other Insured Demographic Information

O

1

Situational

310

OI

Other Insurance Coverage Information

O

1

Required

325

Loop 2330A

O

1

Required

325

Loop 2330B

O

1

Required

325

Loop 2330C

O

1

Situational

325

Loop 2330D

O

1

Situational

325

Loop 2330E

O

1

Situational

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.

Notes:

1. Required if other payers are known to potentially be involved in paying on this claim.
2. Because the usage of this segment is “situational” this is not a syntatically required loop. If the loop is used, then it is a “required” segment. See Appendix A for further details on ASC X12 nomenclature X12 syntax rules.
3. All information contained in the 2320 loop applies only to the payer who is identified in the 2330B Loop of this iteration of the 2320 loop. It is specific only to that payer. If information on additional payers is needed to be carried, run the 2320 loop again with its respective 2330 loops.

Example:

SBR*P*01*003450*GOLDEN PLUS*****CI~