COB Coordination of Benefits

To supply information on coordination of benefits

Position
Element
Name
Type
Requirement
Min
Max
Repeat
COB-01
Payor Responsibility Sequence Number Code
Identifier (ID)
Optional
1
1
-
Code indentifying the insurance carrier's level of responsibility for a payment of a claim
COB-02
Reference Number
String (AN)
Optional
1
30
-
Reference number or identification number as defined for a particular Transaction Set, or as specified by the Reference Number Qualifier.
COB02 is policy number.
COB-03
Coordination of Benefits Code
Identifier (ID)
Optional
1
1
-
Code identifying whether there is a coordination of benefits

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