COO Coordination of Benefits

Interactive

To provide coordination of benefit information.

Elements

PositionElementNameTypeMin/MaxRepeat
I001Reference NumberRel
1
23036Party NameRelAlphanumeric1/351
I011Service Type CodeRel
1
I001Reference NumberRel
1
53036Party NameRelAlphanumeric1/351
61154-IReference NumberRelAlphanumeric1/351
73036Party NameRelAlphanumeric1/351
I004AddressRel
1
I006DateRel
2
104703Insurance Type, codedRelAlphanumeric1/31
I004AddressRel
1
I001Reference NumberRel
1
134711Condition/Response, codedRelAlphanumeric1/31

Element Details

ID3036
NameParty Name
LengthMin 1 / Max 35
Position2
RequirementRel