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_id
• coordination_of_benefits_index

Foreign Keys:

• claim_id => claim.claim_id
• insurer_payer_id => insurer_payer.insurer_payer_id
• member_seen_id => member_seen.member_seen_id

Indexes:

• claim_coordination_of_benefits_insurer_payer_id_idx - insurer_payer_id
• claim_coordination_of_benefits_member_seen_id_idx - member_seen_id

Column	Data Type	Nullable	Indexed	Description
payment_date	date	Yes	No	Date of payment (From DTP 573)
claim_id	bigint	No	Yes	-
coordination_of_benefits_index	smallint	No	Yes	represents coordination of benefits member order in the claim.
payer_responsibility_sequence	payer_responsibility_sequence_type	Yes	No	Payer responsibility order for Coordination of Benefits (From SBR01)
relationship_to_subscriber	individual_relationship_code	Yes	No	Relation of individual to the subscriber (From SBR02 / PAT01)
group_or_policy_number	text	No	No	Subscriber group or policy number (From SBR03)
group_name	text	No	No	Subscriber Group Name (From SBR04)
insurance_type	insurance_type	Yes	No	Type of insurance (From SBR05)
claim_filing_indicator	claim_filing_indicator_type	Yes	No	Type of claim (From SBR09)
payer_amount_paid	numeric	Yes	No	Amount paid by the payer (from AMT02 D)
remaining_patient_liability	numeric	Yes	No	Remaining patient liability (from AMT02 EAF)
noncovered_charge_amount	numeric	Yes	No	Actual non covered charges (from AMT02 A8)
member_seen_id	bigint	No	Yes	Link to member_seen table to get data from NM1, N3, N4, REF, and PER segments
insurer_payer_id	bigint	Yes	Yes	Link to insurer_payer table (From NM1 loop 2010BB)
prior_authorization_number	text	No	No	Prior authorization number (from REF G1)
referral_number	text	No	No	Referral number (from REF 9F)
was_adjusted_by_other_payer	boolean	No	No	Other payer adjusted the claim (from REF T4)
payer_claim_number	text	No	No	Claim number according to the payer or other intermediary (from REF F8)