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Segment
in
X12 Release 003030

SBR Subscriber Information

To record claim information specific to the primary insured and the insurance carrier for that insured
Sequence
Element
Name
Type
Requirement
Min
Max
Repeat
01
1138
Payor Responsibility Sequence Number Code
Identifier (ID)
Mandatory
1
1
-
Code indentifying the insurance carrier's level of responsibility for a payment of a claim
Codes (4)
02
Individual Relationship Code
Identifier (ID)
Optional
2
2
-
Code indicating the relationship between two individuals or entities.
SBR02 specifies the relationship to the person insured.
Codes (41)
03
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.
SBR03 is policy or group number.
04
Name
String (AN)
Optional
1
35
-
Free-form name.
SBR04 is plan name.
05
Insurance Type Code
Identifier (ID)
Optional
1
3
-
Code identifying the type of insurance policy within a specific insurance program
Codes (20)
06
Coordination of Benefits Code
Identifier (ID)
Optional
1
1
-
Code identifying whether there is a coordination of benefits
Codes (7)
07
Yes/No Condition or Response Code
Identifier (ID)
Optional
1
1
-
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.
Codes (3)
08
Employment Status Code
Identifier (ID)
Optional
2
2
-
Code showing the general employment status of an employee/claimant.
Codes (41)
09
Claim Filing Indicator Code
Identifier (ID)
Optional
1
2
-
Code identifying the type of health insurance or program.
Codes (15)
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Stedi is a registered trademark of Stedi, Inc. Stedi's EDI Reference and Mapping Guides are provided for marketing purposes and are free of charge. All names, logos, and brands of third parties listed on our site are trademarks of their respective owners (including “X12”, which is a trademark of X12 Incorporated). Stedi, Inc. and its products and services are not endorsed by, sponsored by, or affiliated with these third parties. Our use of these names, logos, and brands is for identification purposes only, and does not imply any such endorsement, sponsorship, or affiliation.