COB Coordination of Benefits

Opt

AtMax 1

To supply information on coordination of benefits

Elements

Position	Element	Name		Type	Min/Max	Repeat

1	1138	Payer Responsibility Sequence Number Code	Opt	ID	1/1	AtMax 1
2	127	Reference Identification	Opt	Alphanumeric	1/50	AtMax 1
3	1143	Coordination of Benefits Code	Opt	ID	1/1	AtMax 1
4	1365	Service Type Code	Opt	ID	1/2	AtMax 9

ID1138

NamePayer Responsibility Sequence Number Code

LengthMin 1 / Max 1

Position1

RequirementOpt

Codes