claim_coordination_of_benefits

Information about other subscribers that may be responsible for payment during coordination of benefits. Some repricers also use the SBR/CAS segments to indicate the price for a primary payer, even if that is not technically spec compliant

Primary Key:

• claim_coordination_of_benefits_id

Checks:

• claim_coordination_of_benefi_predetermination_of_benefits_check - (predetermination_of_benefits_identifier = upper(predetermination_of_benefits_identifier))
• claim_coordination_of_benefits_group_name_check - (group_name = upper(group_name))
• claim_coordination_of_benefits_group_or_policy_number_check - (group_or_policy_number = upper(group_or_policy_number))
• claim_coordination_of_benefits_payer_claim_number_check - (payer_claim_number = upper(payer_claim_number))
• claim_coordination_of_benefits_prior_authorization_number_check - (prior_authorization_number = upper(prior_authorization_number))
• claim_coordination_of_benefits_referral_number_check - (referral_number = upper(referral_number))

Foreign Keys:

• claim_id => claim.claim_id
• coordination_of_benefits_subscriber_id => coordination_of_benefits_subscriber.coordination_of_benefits_subscriber_id
• insurer_payer_id => insurer_payer.insurer_payer_id

Indexes:

• claim_coordination_of_benefits_claim_id_payer_resp_seq_idx (Unique) - claim_id, payer_responsibility_sequence
• claim_coordination_of_benefits_cob_subscriber_id_idx - coordination_of_benefits_subscriber_id
• claim_coordination_of_benefits_insurer_payer_id_idx - insurer_payer_id

Column	Data Type	Nullable	Indexed	Description
payment_date	date	Yes	No	Date of payment (From DTP 573) Generated through expression:
claim_id	bigint	No	Yes	Link to the claim. Generated through expression:
payer_responsibility_sequence	payer_responsibility_sequence_type	Yes	Yes	Payer responsibility order for Coordination of Benefits (From SBR01) Generated through expression:
relationship_to_subscriber	individual_relationship_type	Yes	No	Relation of individual to the subscriber (From SBR02 / PAT01 / UB04 FL59) Generated through expression:
group_or_policy_number	text	No	No	Subscriber group or policy number (From SBR03 / UB04 FL62 / HCFA item 9a) Generated through expression:
group_name	text	No	No	Subscriber Group Name (From SBR04 / UB04 FL61 / HCFA item 9d) Generated through expression:
insurance_type	insurance_type	Yes	No	Type of insurance (From SBR05) Generated through expression:
claim_filing_indicator	claim_filing_indicator_type	Yes	No	Type of claim (From SBR09) Generated through expression:
payer_amount_paid	numeric	Yes	No	Amount paid by the payer (from AMT02 D / UB04 FL54) Generated through expression:
remaining_patient_liability	numeric	Yes	No	Remaining patient liability (from AMT02 EAF / UB04 FL55) Generated through expression:
non_covered_charge_amount	numeric	Yes	No	Actual non covered charges (from AMT02 A8) Generated through expression:
insurer_payer_id	bigint	Yes	Yes	Link to insurer_payer table (From NM1 loop 2010BB / UB04 FL50-51) Generated through expression:
prior_authorization_number	text	No	No	Prior authorization number (from REF G1 / UB04 FL63) Generated through expression:
referral_number	text	No	No	Referral number (from REF 9F) Generated through expression:
payer_claim_number	text	No	No	Claim number according to the payer or other intermediary (from REF F8 / UB04 FL64) Generated through expression:
claim_coordination_of_benefits_id	bigint	No	Yes	Snowflake ID for this coordination of benefits record. Generated through expression:
coordination_of_benefits_subscriber_id	bigint	No	Yes	Link to coordination_of_benefits_subscriber table to get data from NM1, N3, N4, and segments Generated through expression:
other_payer_claim_adjustment_indicator	text	No	No	Identifies when a payer earlier in the COB has re-adjudicated the claim and the claim is being sent payer-to-payer (from REF T4) Generated through expression:
predetermination_of_benefits_identifier	text	No	No	Predetermination of benefits identifier (from REF G3) Generated through expression: