COB Coordination of Benefits

To supply information on coordination of benefits

Position
Element
Name
Type
Requirement
Min
Max
Repeat
COB01
Payer Responsibility Sequence Number Code
Identifier (ID)
Optional
1
1
1
Code identifying the insurance carrier's level of responsibility for a payment of a claim
COB02
Reference Identification
String (AN)
Optional
1
80
1
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
COB02 is the policy number.
COB03
Coordination of Benefits Code
Identifier (ID)
Optional
1
1
1
Code identifying whether there is a coordination of benefits
COB04
Service Type Code
Identifier (ID)
Optional
1
2
9
Code identifying the classification of service

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