EDI 5010 Documentation 837 Professional - LOOP 2000B Subscriber Hierarchical Level

2000B Subscriber Hierarchical Level

        

For this Loop, Take the information from Patient Insurance and Insurance Master details.

 

Loop	Seg ID	Segment Name	Format	Length	Ref#	Req	Value
2000B	HL	Subscriber Hierarchical Level	ID	2		R	HL
		Element Separator	AN	1			*
	HL01	Subscriber ID Number	AN	1/12	628	R	2
		Element Separator	AN	1			*
	HL02	Hierarchical Parent ID Number	AN	1/12	734	R	1
		Element Separator	AN	1			*
	HL03	Hierarchical Level Code	ID	1/2	735	R	22
		Element Separator	AN	1			*
	HL04	Hierarchical Child Code	ID	1/1	736	R	0
		Segment Terminator					~

 

 

2000B Subscriber Information

Loop	Seg ID	Segment Name	Format	Length	Ref#	Req	Value
2000B	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.

 

2000B Subscriber Information – Sample

Test data  -  Use case 1:

 

Insurance Master Setup

Field	Value
Insurance Name	Cigna
Insurance Program	ZZ  (Mutually Defined). Drop down. Values should be from this list

 

Test data – Patient Insurance Policy Setup

Field	Value
Insurance Plan	Cigna Prim Plan
Patient Relation	Self
Group Name	XYZ
Group Number	492929

 

Destination payer is Cigna and patient is same as the subscriber.

SBR*P*18*492929*XYZ*****ZZ~

****************************************************************************************************************

 

 

Test data - Use case 2:

Insurance Master Setup

Field	Value
Insurance Name	Medicare
Insurance Program	MB  ( Medicare Part B). Drop down. Values should be from this list

Test data – Patient Insurance Policy Setup

Field	Value
Insurance Plan	Medicare Plan
Patient Relation	Child
Group Name	Premium Plus
Group Number	ABC34F3

Destination payer is Medicare and patient is NOT same as the subscriber.

SBR*P**ABC34F3*Premium Plus*****MB~

 

Test data - Use case 3:

Insurance Master Setup

Field	Value
Insurance Name	Medicare
Insurance Program	MB ( Medicare Part B). Drop down. Values should be from this list

 

Test data – Patient Insurance Policy Setup

Field	Value
Insurance Plan	Medicare Plan
Patient Relation	Child
Group Name	Premium Plus
Group Number	ABC34F3
Secondary Type	41 Drop down. Values should be from this list .

 

Destination payer is Medicare WHICH IS AT THE 5TH Level and patient is NOT same as the subscriber.

SBR*B**ABC34F3*Premium Plus*41****MB~

 

        

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