COB Coordination of Benefits

To supply information on coordination of benefits

Sequence

Element

Name

Type

Requirement

Min

Max

Repeat

01

1138

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

Codes (15)

02

127

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.

03

1143

Coordination of Benefits Code

Identifier (ID)

Optional

1

1

1

Code identifying whether there is a coordination of benefits

Codes (9)

04

1365

Service Type Code

Identifier (ID)

Optional

1

2

9

Code identifying the classification of service

Codes (192)