This article dives into the specifics of Loop 2000B and assumes that you know how to read an EDI (837) file. If you are looking for a general outline of an EDI and how to read the basic structure, please see: How to read an EDI (837) File - Overview.

We will be using the following sample EDI file to break down this loop.

Loop 2000B - Subscriber (SBR)

Segment HL - Heirarchy

Example: HL*2*1*22*0~

• Element 01 = Level (2)
• Element 02 = Parent ID (1)
• Element 03 = Hardcoded to 22
• Element 04 = Patient Relationship (0)
  • 0 = Self
  • 1 = Other

Segment SBR - Subscriber

Example: SBR*P*18*A84695******12~

• Element 01 = Payer Responsibility (P)
  • P = Primary
  • S = Secondary
  • T = Tertiary
• Element 02 = Client Relationship to Insured (18) Box 6
  • 01 = Spouse
  • 18 = Self
  • 19 = Child
  • G8 = Other
• Element 03 = Policy/Group Number (A84695) Box 11
• Element 04 = Plan/Program Box 11c
• Element 05 = Medicare Secondary Payer (MSP) code
  • 12 = Working Age
  • 13 = End-Stage Renal
  • 14 = No-Fault Including Auto
  • 15 = Workers Compensation
  • 16 = Public Health or Federal
  • 41 = Secondary Black Lung
  • 42 = Veterans Administration
  • 43 = Disabled Under 65
  • 47 = Other Liability is Primary
• Element 09 = Plan Type (12) Box 1
  
  • 11 = Other Non-Federal Program
  • 12 = Preferred Provider Organization (PPO)
    
  • 13 = Point of Service (POS)
    
  • 14 = Exclusive Provider Organization (EPO)
    
  • 16 = Health Maintenance Organization (HMO) Medicare Risk
    
  • AM = Automobile Medical
    
  • BL = Blue Cross/Blue Shield
    
  • CH = Champus
    
  • CI = Commercial Insurance Co.
    
  • DS = Disability
    
  • FI = Federal Employee Program
  • HM = Health Maintenance Organization (HMO)
    
  • MB = Medicare Part B
    
  • MC = Medicaid
    
  • OF = Other Federal Program
    
  • WC = Workers' Compensation Health Claim

Loop 2010BA - Subscriber (SBR) Name

Segment NM1 - Name

Example: NM1*IL*1*SPEARS*BRITNEY*J***MI*75893251~

• Element 01 = Hardcoded to IL for Insured
• Element 02 = Insured Party (1)
  • 1 = Individual
  • 2 = Entity (Workers Comp)
• Element 03 = Last Name/Employer Name (Spears) Box 4 (also Box 2 if 2010CA is not present)
• Element 04 = First Name (Britney) Box 4 (also Box 2 if 2010CA is not present)
• Element 05 = Middle Name/Initial (J) Box 4 (also Box 2 if 2010CA is not present)
• Element 07 = Suffix Box 4 (also Box 2 if 2010CA is not present)
• Element 08 = Identification Code Qualifier
  • MI = Member ID
• Element 09 = Identification Code (75893251) Box 1a

Segment N3 - Street Address

Example: N3*398 W STAFFORD RD.~

• Element 01 = Street Address (398 W Stafford Rd.) Box 7 (also Box 5 if 2010CA is not present)
• Element 02 = Street Address 2 Box 7 (also Box 5 if 2010CA is not present)

Segment N4 - City, State, and ZIP

Example: N4*THOUSAND OAKS*CA*91361~

• Element 01 = City (Thousand Oaks) Box 7 (also Box 5 if 2010CA is not present)
• Element 02 = State (California) Box 7 (also Box 5 if 2010CA is not present)
• Element 03 = ZIP (91361) Box 7 (also Box 5 if 2010CA is not present)

Segment DMG - Demographic

Example: DMG*D8*19811202*F~

• Element 01 = Hardcoded to D8
• Element 02 = Birthdate - YYYYMMDD (1981/12/02) Box 11a (also Box 3 if 2010CA is not present)
• Element 03 = Gender (F) Box 11a (also Box 3 if 2010CA is not present)
  
  • F = Female
  • M = Male

Segment REF - Reference (Workers Comp and Auto)

Example: REF*Y4*WC1234567~

• Element 01 - Identification Code Qualifier (Y4)
  • Y4 - Claim Casualty Number Box 11b
  • SY - SSN
• Element 02 - Identification Code (WC1234567) Box 11b if Y4 is qualifier

Loop 2010BB - Payer Name

Segment NM1 - Name

Example: NM1*PR*2*AETNA INSURANCE COMPANY*****PI*60054~

• Element 01 = Hardcoded to PR for Payer
• Element 02 = Hardcoded to 2 for Organization
• Element 03 = Payer Name (Aetna Insurance Company) Header
• Element 08 = Hardcoded to PI for Payer ID
• Element 09 = Identification Code/Payer ID (60054)

Segment N3 - Street Address

Example: N3*123 FAKE ST~

• Element 01 = Street Address (123 Fake St) Header
• Element 02 = Street Address 2 Header

Segment N4 - City, State, and ZIP

Example: N4*PHOENIX*AZ*85050~

• Element 01 = City (Phoenix) Header
• Element 02 = State (Arizona) Header
• Element 03 = ZIP (85050) Header