SBR

Other Subscriber Information

Pos: 290

Max: 1

Detail - Optional

Loop: 2320

Elements: 6

User Option (Usage): Situational

To record information specific to the primary insured and the insurance carrier for that insured

Element Summary:

	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 Alias: Payer responsibility sequence number code NSF Reference: DA0-02.0, DA1-02.0, DA2-02.0	M	ID	1/1	Required

	Code	Name
	P	Primary
	S	Secondary
	T	Tertiary

SBR02

1069

Individual Relationship Code
Description: Code indicating the relationship between two individuals or entities
Alias: Individual relationship code
NSF Reference: DA0-17.0

2/2

Required

	Code	Name
	01	Spouse
	04	Grandfather or Grandmother
	05	Grandson or Granddaughter
	07	Nephew or Niece
	10	Foster Child
	15	Ward
	17	Stepson or Stepdaughter
	18	Self
	19	Child
	20	Employee
	21	Unknown
	22	Handicapped Dependent
	23	Sponsored Dependent
	24	Dependent of a Minor Dependent
	29	Significant Other
	32	Mother
	33	Father
	36	Emancipated Minor
	39	Organ Donor
	40	Cadaver Donor
	41	Injured Plaintiff
	43	Child Where Insured Has No Financial Responsibility
	53	Life Partner
	G8	Other Relationship

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 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: Other Insured Group Name Alias: Group or Plan Name NSF Reference: DA0-11.0 Required if the subscriber�s payer identification includes a Group or Plan Name.	O	AN	1/60	Situational
SBR05	1336	Insurance Type Code Description: Code identifying the type of insurance policy within a specific insurance program Alias: Insurance type code NSF Reference: DA0-06.0	O	ID	1/3	Required

	Code	Name
	AP	Auto Insurance Policy
	C1	Commercial
	CP	Medicare Conditionally Primary
	GP	Group Policy
	HM	Health Maintenance Organization (HMO)
	IP	Individual Policy
	LD	Long Term Policy
	LT	Litigation
	MB	Medicare Part B
	MC	Medicaid
	MI	Medigap Part B
	MP	Medicare Primary
	OT	Other
	PP	Personal Payment (Cash - No Insurance)
	SP	Supplemental Policy

SBR09

1032

Claim Filing Indicator Code
Description: Code identifying type of claim
Alias: Claim filing indicator code
NSF Reference: DA0-05.0
Required prior to mandated used of PlanID. Not used after PlanID is mandated.

1/2

Situational

Code

Name

Self-pay

Central Certification

NSF Reference:

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

Other Non-Federal Programs

Preferred Provider Organization (PPO)

Point of Service (POS)

Exclusive Provider Organization (EPO)

Indemnity Insurance

Health Maintenance Organization (HMO) Medicare Risk

Automobile Medical

Blue Cross/Blue Shield

Champus

Commercial Insurance Co.

Disability

Health Maintenance Organization

Liability

Liability Medical

Medicare Part B

Medicaid

Other Federal Program

Title V

Veteran Administration Plan

Refers to Veterans Affairs Plan.

Workers' Compensation Health Claim

Mutually Defined

Unknown

Semantics:

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 syntactically required loop. If this loop is used, then this segment is a �Required� segment. See Appendix A for further details on ASC 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 it�s respective 2330 Loops.
See Section 1.4.4 for more information on handling COB.
4. See Section 1.4.5 Crosswalking COB Data Elements for more information on handling COB in the 837.

Example:

SBR*S*01*GR00786**MC****OF~

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