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	1/80	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

Element Details

ID1138

NamePayer Responsibility Sequence Number Code

LengthMin 1 / Max 1

Position1

RequirementOpt

Codes

<>G
Payer Responsibility Ten
<>P
Primary
<>N
Unconfirmed
<>A
Payer Responsibility Four
<>D
Payer Responsibility Seven
<>T
Tertiary
<>O
Noncapitated Agreement
<>B
Payer Responsibility Five
<>R
Non-specified
<>E
Payer Responsibility Eight
<>U
Unknown
<>H
Payer Responsibility Eleven
<>C
Payer Responsibility Six
<>S
Secondary
<>F
Payer Responsibility Nine