SBR Subscriber Information

Opt

AtMax 1

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

Elements

Position	Element	Name		Type	Min/Max	Repeat

1	1138	Payer Responsibility Sequence Number Code	Mandatory	ID	1/1	Exact 1
2	1069	Individual Relationship Code	Opt	ID	2/2	Exact 1
3	127	Reference Identification	Opt	Alphanumeric	1/30	Exact 1
4	93	Name	Opt	Alphanumeric	1/60	Exact 1
5	1336	Insurance Type Code	Opt	ID	1/3	Exact 1
6	1143	Coordination of Benefits Code	Opt	ID	1/1	Exact 1
7	1073	Yes/No Condition or Response Code	Opt	ID	1/1	Exact 1
8	584	Employment Status Code	Opt	ID	2/2	Exact 1
9	1032	Claim Filing Indicator Code	Opt	ID	1/2	Exact 1

ID1138

NamePayer Responsibility Sequence Number Code

LengthMin 1 / Max 1

Position1

RequirementMandatory

Codes