Other Insurance Coverage Information

Pos: 310

Max: 1

Detail - Optional

Loop: 2320

Elements: 2

User Option (Usage): Required

To specify information associated with other health insurance coverage

Element Summary:

	Ref	Id	Element Name	Req	Type	Min/Max	Usage
	OI03	1073	Yes/No Condition or Response Code Description: Code indicating a Yes or No condition or response Industry: Benefits Assignment Certification Indicator NSF Reference: DA0-15.0 This code is a crosswalk from CLM08 when doing COB.	O	ID	1/1	Required

	Code	Name
	N	No
	Y	Yes

OI06

1363

Release of Information Code
Description: Code indicating whether the provider has on file a signed statement by the patient authorizing the release of medical data to other organizations
Alias: Release of Information
This code is a crosswalk from CLM09 when doing COB.

1/1

Required

	Code	Name
	N	No, Provider is Not Allowed to Release Data
	Y	Yes, Provider has a Signed Statement Permitting Release of Medical Billing Data Related to a Claim

Semantics:

1.	OI03 is the assignment of benefits indicator. A "Y" value indicates insured or authorized person authorizes benefits to be assigned to the provider; an "N" value indicates benefits have not been assigned to the provider.

Notes:

1. All information contained in the OI segment 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.

Example:

OI***Y***Y~

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