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
Alias: Payer Responsibility Sequence Number Code
NSF Reference: DA1-02.0, DA0-02.0, DA2-02.0

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: Relationship Code
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
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: 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
Required when the destination payer (Loop 2010BB) is Medicare and Medicare is not the primary payer (SBR01 equals “S” or “T”).

O

ID

1/3

Situational

Code

Name

12

Medicare Secondary Working Aged Beneficiary or Spouse with Employer Group Health Plan

13

Medicare Secondary End-Stage Renal Disease Beneficiary in the 12 month coordination period with an employer's group health plan

14

Medicare Secondary, No-fault Insurance including Auto is Primary

15

Medicare Secondary Worker's Compensation

16

Medicare Secondary Public Health Service (PHS)or Other Federal Agency

41

Medicare Secondary Black Lung

42

Medicare Secondary Veteran's Administration

43

Medicare Secondary Disabled Beneficiary Under Age 65 with Large Group Health Plan (LGHP)

47

Medicare Secondary, Other Liability Insurance is Primary

SBR09

1032

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

O

ID

1/2

Situational

Code

Name

09

Self-pay

10

Central Certification

NSF Reference:

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

11

Other Non-Federal Programs

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

AM

Automobile Medical

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), DA0-05.0 (H)

CI

Commercial Insurance Co.

NSF Reference:

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

DS

Disability

HM

Health Maintenance Organization

NSF Reference:

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

LI

Liability

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)

OF

Other Federal Program

NSF Reference:

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

TV

Title V

NSF Reference:

DA0-05.0 (T)

VA

Veteran Administration Plan

NSF Reference:

DA0-05.0 (V)

WC

Workers' Compensation Health Claim

NSF Reference:

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

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******MB~