Segment
X12 EDI Release 00701
To record information specific to the primary insured and the insurance carrier for that insured
Elements
  • SBR011138Payer Responsibility Sequence Number Code
    ID
    M必须(Mandatory)

    Code identifying the insurance carrier's level of responsibility for a payment of a claim

    Codes (14)
  • SBR021069Individual Relationship Code
    ID
    O可选(Optional)

    Code indicating the relationship between two individuals or entities

    Codes (155)
  • SBR03127Reference Identification
    AN
    O可选(Optional)
    Min 1 / Max 80

    Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier

  • SBR0493Name
    AN
    O可选(Optional)
    Min 1 / Max 60

    Free-form name

  • SBR051336Insurance Type Code
    ID
    O可选(Optional)

    Code identifying the type of insurance policy within a specific insurance program

    Codes (63)
  • SBR061143Coordination of Benefits Code
    ID
    O可选(Optional)

    Code identifying whether there is a coordination of benefits

    Codes (9)
  • SBR071073Yes/No Condition or Response Code
    ID
    O可选(Optional)

    Code indicating a Yes or No condition or response

    Codes (4)
  • SBR08584Employment Status Code
    ID
    O可选(Optional)

    Code indicating the general employment status of an employee/claimant

    Codes (91)
  • SBR091032Claim Filing Indicator Code
    ID
    O可选(Optional)

    Code identifying type of claim

    Codes (50)
  • SBR101732Source of Payment Typology Code
    ID
    O可选(Optional)
    Min 2 / Max 6

    Code identifying payer types in the most granular way