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_idx - claim_id
• 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 / NCPDP 443-E8) 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 / NCPDP 338-5C) 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 / NCPDP 993-A7) 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	Yes	Yes	Link to coordination_of_benefits_subscriber table to get data from NM1, N3, N4, and segments. Required in the EDI spec, but not always supplied by trading partners, so it is nullable. 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:
rx_delivery_payment	text	No	No	Amount paid related to service/product delivery (from NCPDP 431-DV) Generated through expression:
rx_shipping_payment	text	No	No	Amount paid related to product transportation (from NCPDP 431-DV) Generated through expression:
rx_postage_payment	text	No	No	Amount paid related to product mailing (from NCPDP 431-DV) Generated through expression:
rx_administrative_payment	text	No	No	Amount paid related to administrative activities such as claims processing, DUR, etc. (from NCPDP 431-DV) Generated through expression:
rx_incentive_payment	text	No	No	Amount paid related to provider activities such as survey data collection, plan enrollee counseling, etc. (from NCPDP 431-DV) Generated through expression:
rx_cognitive_professional_services	text	No	No	Amount paid for pharmacist services beyond basic dispensing (from NCPDP 431-DV) Generated through expression:
rx_drug_benefit_payment	text	No	No	The plan benefit payment amount (from NCPDP 431-DV) Generated through expression:
rx_compound_preparation_payment	text	No	No	Amount paid related to compound preparation (from NCPDP 431-DV) Generated through expression:
rx_sales_tax_payment	text	No	No	Amount paid related to sales tax (from NCPDP 431-DV) Generated through expression:
rx_medication_administration_payment	text	No	No	Amount paid related to medication administration (from NCPDP 431-DV) Generated through expression:
rx_regulatory_fee_payment	text	No	No	Amount paid related to regulatory fees (from NCPDP 431-DV) Generated through expression:
rx_manufacturer_chargeback_payable_by_plan	text	No	No	Manufacturer chargeback that the plan is responsible for (from NCPDP 431-DV) Generated through expression:
rx_manufacturer_chargeback_payable_by_other_entity	text	No	No	Manufacturer chargeback that must be paid by a party other than the plan (from NCPDP 431-DV) Generated through expression:
rx_percentage_tax_payment	text	No	No	Amount paid related to percentage tax (from NCPDP 431-DV) Generated through expression:
rx_medication_synchronization_payment	text	No	No	Amount paid related to the process of coordinating patient prescription refills (from NCPDP 431-DV) Generated through expression:
rx_adherence_packaging_payment	text	No	No	Amount paid related to packaging medication in a way that helps the patient take the medication correctly (from NCPDP 431-DV) Generated through expression:
patient_assigned_benefits	yes_no_response_type	Yes	No	A 'Y' value indicates insured or authorized person authorizes benefits to be assigned to the provider; an 'N' value indicates benefits have not been assigned to the provider. (from X12 EDI OI03) Generated through expression:
patient_signature_source	patient_signature_source_type	Yes	No	[Professional claims only] Code indicating how the patient or subscriber authorization signatures were obtained and how they are being retained by the provider (from X12 EDI OI04) Generated through expression:
release_of_information	release_of_information_type	Yes	No	Code indicating whether the provider has on file a signed statement by the patient authorizing the release of medical data to other organizations (from X12 EDI OI06) Generated through expression: