SBR Subscriber Information

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

Position
Element
Name
Type
Requirement
Min
Max
Repeat
SBR-01
Payer Responsibility Sequence Number Code
Identifier (ID)
Mandatory
1
1
-
Code identifying the insurance carrier's level of responsibility for a payment of a claim
SBR-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.
SBR-03
Reference Identification
String (AN)
Optional
1
30
-
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
SBR03 is policy or group number.
SBR-04
Name
String (AN)
Optional
1
60
-
Free-form name
SBR04 is plan name.
SBR-05
Insurance Type Code
Identifier (ID)
Optional
1
3
-
Code identifying the type of insurance policy within a specific insurance program
SBR-06
Coordination of Benefits Code
Identifier (ID)
Optional
1
1
-
Code identifying whether there is a coordination of benefits
SBR-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.
SBR-08
Employment Status Code
Identifier (ID)
Optional
2
2
-
Code showing the general employment status of an employee/claimant
SBR-09
Claim Filing Indicator Code
Identifier (ID)
Optional
1
2
-
Code identifying type of claim

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