Loop 2320 - Other Subscriber Information - Electronic file submission

Loops and Segments Table - Loop 2320 - Other Subscriber Information.

Required if other payers are known to potentially be involved in paying on this claim.


Usage : Required
Element : SBR01
Value :
P=Primary
S =Secondary
T=Tertiary
Use to indicate 'payer of last resort'

Comment : Code identifying the insurance carrier's level of responsibility for payment of a claim. If claim is being sent to Medicare Part B the code would be "P" to identify primary information.


Usage : Required
Element : SBR02 
Value :
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

Comment : Specifies the relationship to the insured


Usage : Situational
Element : SBR03
Value : Nil
Comment : Policy or group number


Usage : Situational
Element : SBR04
Value : Nil
Comment : Name of plan.


Usage : Required
Element : SBR05
Value :
AP = Auto Insurance Policy
C1 = Commercial
CP = Medicare Conditionally Primary
GP = Group Policy
HM = Health Maintenance Organization (HM0)
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

Comment : Code to identify the type of insurance policy within a specific insurance program.



Usage : Required
Element : SBR09
Value :
09 = Selfpay
10 = Central Certification
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
CH = Champus
CI=Commercial Insurance Co
DS= Disability
HM = Health Maintenance Organization
LI = Liability
LM = Liability Medical
MB= Medicare part B
MC = Medicaid
OF = Other Federal Program
TV= Title V
VA=Veteran Administration Plan Refers To Veterans Affairs Plan
WC = Workers' Compensation Health Claim
ZZ = Mutually Defined Unknown

Comment : Code to identify the type of claim.