EDI 5010 Documentation 837 Professional - Loop 2320 Other Subscriber Information

2320  Other Subscriber Information

This loop is required only if current insurance sequence > 1. i.e. for secondary, tertiary, etc.

Say for example, if the current insurance is secondary, then we should run this loop for the primary insurance. If the current insurance is tertiary, then we should run this loop for the primary and then secondary insurance. And also so on. In general, take the sequence number of the current insurance, and run this loop for all the previous sequence insurance.

 

2320 Other  Subscriber Information

Loop	Seg ID	Segment Name	Format	Length	Ref#	Req	Value
2320	SBR	Subscriber Information	ID	3		R	SBR
		Element Separator	AN	1			*
	SBR01	Payer Responsibility Code	ID	1/1	1138	R	See below for more information
		Element Separator	AN	1			*
	SBR02	Individual Relationship code	ID	2/2	1069	S	If Subscriber is same person as of the patient, then Print 18, else do not print , just append element separator.
		Element Separator	AN	1			*
	SBR03	Reference Identification	AN	1/50	127	S	Print Patient –> Insurance –> Group Number
		Element Separator	AN	1			*
	SBR04	Name	AN	1/60	93	S	Print Patient-> Insurance-> Group Name
		Element Separator	AN	1			*
	SBR05	Insurance Type Code	ID	1/3	1336	S	See below for more information
		Element Separator	AN	1			*
	SBR06	Coordination of Benefit code				Not Used	*
	SBR07	Yes/No Condition				Not Used	*
	SBR08	Employment Status Code				Not Used	*
	SBR09	Claim filling Indicator Code	ID	1/2	1032	S	See below for more information
		Segment Terminator					~

SBR01 – Payer Responsibility Sequence Number Code

Code	Definition
P	Primary
S	Secondary
T	Tertiary
A	Code for the 4th Insurance
B	Code for the 5th Insurance
C	Code for the 6th Insurance
D	Code for the 7th Insurance
E	Code for the 8th Insurance
F	Code for the 9th Insurance
G	Code for the 10th Insurance
H	Code for the 11th Insurance

SBR05 – Insurance Type Code

2000B SBR05 is required when Medicare is the destination payer but not the primary payer i.e Medicare would be the second or third payer. We should capture this field either in the Patient Insurance Policy information or at the claim level.

Code	Definition
12	Medicare Secondary Working Aged Beneficiary or Spouse with Employer Group Health Plan
13	Medicare Secondary End Stage Renal Disease
14	Medicare Secondary , No Fault Insurance including Auto is Primary
15	Medicare Secondary Worker’s Compensation
16	Medicare Secondary Public Health Service (PHS) or other Federal Agency
16	Medicare Secondary Public Health Service
41	Medicare Secondary Black Lung
42	Medicare Secondary Veteran’s Administration
43	Medicare Secondary Veteran’s Administration
47	Medicare Secondary, Other Liability Insurance is Primary

SBR09 – Claim Filling indicator code

We should capture this field (single selection drop down) in the insurance master screen for each insurance.

Code	Definition
11	Other Non-Federal Programs
12	Preferred Provider Organizations
13	Point of Service
14	Exclusive Provider Organization
15	Indemnity Insurance
16	Health Maintenance Organization (HMO) Medicare Risk
17	Dental Maintenance Organization
AM	Automobile Medical
BL	Blue Cross/Blue Shield
CH	Champus
CI	Commercial Insurance Co
DS	Disability
HM	Health Maintenance Organization
LM	Liability Medical
MB	Medicare Part B
MC	Medicaid
MA	Medicare Part A
OF	Other Federal Program
TV	Title V
VA	Veteran Administration Plan
WC	Worker’s Compensation Health Claim
FI	Federal Employees Program
ZZ	Mutually Defined.

 

 

2320 Coordination of Benefits (COB) Payer Paid Amount

Loop	Seg ID	Segment Name	Format	Length	Ref#	Req	Value
2320	AMT	Payer Paid Amount	ID	3		R	AMT
		Element Separator	AN	1			*
	AMT01	Amount Qualifier Code	ID	1/3	522	R	D = Payer Amount Paid
		Element Separator	AN	1			*
	AMT02	Monetary Amount	ID	1/18	782	R	Print the Paid Amount
		Segment Terminator					~

 

2320 Coordination of Benefits (COB) Payer Allowed Amount

Loop	Seg ID	Segment Name	Format	Length	Ref#	Req	Value
2320	AMT	Payer Paid Amount	ID	3		R	AMT
		Element Separator	AN	1			*
	AMT01	Amount Qualifier Code	ID	1/3	522	R	B6 = Allowed Amount
		Element Separator	AN	1			*
	AMT02	Monetary Amount	ID	1/18	782	R	Print the Allowed Amount
		Segment Terminator					~

 

2320 Subscriber Demographic Information

Loop	Seg ID	Segment Name	Format	Length	Ref#	Req	Value
2320	DMG	Subscriber Demographic	ID	3		R	DMG
		Element Separator	AN	1			*
	DMG01	Date time Period Format Qualifier	ID	2/3	1250	R	D8
		Element Separator	AN	1			*
	DMG02	Date time Period	AN	1/35	1251	R	Insured Date of birth in the Format CCYYMMDD
		Element Separator	AN	1			*
	DMG03	Gender Code	ID	1	1068	R	Print M for Male Print F for Female Print U for unknown
		Segment Terminator					~

 

 

2320 Other Insurance Coverage Information.

Loop	Seg ID	Segment Name	Format	Length	Ref#	Req	Value
2320	OI	Other Insurance Coverage	ID	2		s	OI
		Element Separator	AN	1			*
	OI01	Claim Filling Indicator Code	ID	1/2	1032	Not Used
		Element Separator	AN	1			*
	OI02	Claim Submission Reason Code	ID	2/2	1383	Not Used
		Element Separator	AN	1			*
	OI03	Yes/No Assignments of Benefit	ID	1/1	1073	R	Y
		Element Separator	AN	1			*
	OI04	Patient Signature Source Code	ID	1/1	1351	R	B
		Element Separator	AN	1			*
	OI05	Provider Agreement Code	ID	1/1	1360	Not Used
		Element Separator	AN	1			*
	OI06	Yes/No Release of Information Code	ID	1/1	1363	R	Y
		Segment Terminator					~

 

 

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