SBR Subscriber Information

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

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Position

Element

Name

Type

Requirement

Min

Max

Repeat

SBR01

1138

Payer Responsibility Sequence Number Code

Identifier (ID)

Mandatory

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

SBR02

1069

Individual Relationship Code

Identifier (ID)

Optional

Code indicating the relationship between two individuals or entities

SBR02 specifies the relationship to the person insured.

SBR03

127

Reference Identification

String (AN)

Optional

Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier

SBR03 is policy or group number.

SBR04

Name

String (AN)

Optional

Free-form name

SBR04 is plan name.

SBR05

1336

Insurance Type Code

Identifier (ID)

Optional

Code identifying the type of insurance policy within a specific insurance program

SBR06

1143

Coordination of Benefits Code

Identifier (ID)

Optional

Code identifying whether there is a coordination of benefits

SBR07

1073

Yes/No Condition or Response Code

Identifier (ID)

Optional

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.

SBR08

584

Employment Status Code

Identifier (ID)

Optional

Code indicating the general employment status of an employee/claimant

SBR09

1032

Claim Filing Indicator Code

Identifier (ID)

Optional

Code identifying type of claim

SBR10

1732

Source of Payment Typology Code

Identifier (ID)

Optional

Code identifying payer types in the most granular way