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

Code identifying the insurance carrier's level of responsibility for a payment of a claim

COB02

Reference Identification

String (AN)

Optional

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

Code identifying whether there is a coordination of benefits

COB04

Service Type Code

Identifier (ID)

Optional

Code identifying the classification of service