SBR Subscriber Information

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

Position: SBR-01 · Element: 1138 · Name: Payer Responsibility Sequence Number Code · Type: Identifier (ID) · Requirement: Mandatory · Min: 1 · Max: 1 · Repeat: -

Code indentifying the insurance carrier's level of responsibility for a payment of a claim

Position: SBR-02 · Element: 1069 · Name: Individual Relationship Code · Type: Identifier (ID) · Requirement: Optional · Min: 2 · Max: 2 · Repeat: -

Code indicating the relationship between two individuals or entities.

SBR02 specifies the relationship to the person insured.

Position: SBR-03 · Element: 127 · Name: Reference Number · Type: String (AN) · Requirement: Optional · Min: 1 · Max: 30 · Repeat: -

Reference number or identification number as defined for a particular Transaction Set, or as specified by the Reference Number Qualifier.

SBR03 is policy or group number.

Position: SBR-04 · Element: 93 · Name: Name · Type: String (AN) · Requirement: Optional · Min: 1 · Max: 35 · Repeat: -

Free-form name.

SBR04 is plan name.

Position: SBR-05 · Element: 1336 · Name: Insurance Type Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 3 · Repeat: -

Code identifying the type of insurance policy within a specific insurance program

Position: SBR-06 · Element: 1143 · Name: Coordination of Benefits Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 1 · Repeat: -

Code identifying whether there is a coordination of benefits

Position: SBR-07 · Element: 1073 · Name: Yes/No Condition or Response Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 1 · Repeat: -

Code indicating a Yes or No condition or response.

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.

Position: SBR-08 · Element: 584 · Name: Employment Status Code · Type: Identifier (ID) · Requirement: Optional · Min: 2 · Max: 2 · Repeat: -

Code showing the general employment status of an employee/claimant.

Position: SBR-09 · Element: 1032 · Name: Claim Filing Indicator Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 2 · Repeat: -

Code identifying type of claim