EDI invalid : SBR05 required...

I am new to claim clean up and filing in my office. Just started last week with no training. So I'm working my invalids in EDI and I have a couple this morning with this error:

SBR05 is required when Medicare or other federal program is not primary. Even when it is the other insurance in Loop 2320.

Anyone know what this means or can help me out?

Thank you.

re: EDI invalid : SBR05 required...

this is a list of codes that I found when I gooled your statement. Scroll down to your error code and it will tell you what information they are looking for:


Loops and Segments Table - Loop 2320 - Other Subscriber Information.

Required if other payers are known to potentially be involved in paying on this claim.


Usage : Required
Element : SBR01
Value :
P=Primary
S =Secondary
T=Tertiary
Use to indicate 'payer of last resort'

Comment : Code identifying the insurance carrier's level of responsibility for payment of a claim. If claim is being sent to Medicare Part B the code would be "P" to identify primary information.


Usage : Required
Element : SBR02
Value :
01 = Spouse
04 = Grandfather or Grandmother
05 = Grandson or Granddaughter
07 = Nephew or Niece
10 = Foster Child
15 = Ward
17 = Stepson or Stepdaughter
18 = Self
19 = Child
20 = Employee
21=Unknown
22 = Handicapped Dependent
23 = Sponsored Dependent
24 = Dependent of a Minor Dependent
29 = Significant Other
32 = Mother
33 = Father
36 = Emancipated Minor
39= Organ Donor
40 = Cadaver Donor
41 = Injured Plaintiff
43 = Child Where Insured has No Financial Responsibility
53 = Life Partner
G8 = Other Relationship

Comment : Specifies the relationship to the insured


Usage : Situational
Element : SBR03
Value : Nil
Comment : Policy or group number


Usage : Situational
Element : SBR04
Value : Nil
Comment : Name of plan.


Usage : Required
Element : SBR05
Value :
AP = Auto Insurance Policy
C1 = Commercial
CP = Medicare Conditionally Primary
GP = Group Policy
HM = Health Maintenance Organization (HM0)
IP = Individual Policy
LD = Long Term Policy
LT = Litigation
MB = Medicare Part B
MC = Medicaid
MI = Medigap Part B
MP = Medicare Primary
OT = Other
PP = Personal Payment (Cash - No Insurance)
SP = Supplemental Policy

Comment : Code to identify the type of insurance policy within a specific insurance program.



Usage : Required
Element : SBR09
Value :
09 = Selfpay
10 = Central Certification
11 = Other Non-Federal Programs
12 = Preferred Provider Organization (PPO)
13 = Point of Service (POS)
14 = Exclusive Provider Organization (EPO)
15 = Indemnity Insurance
16 = Health Maintenance Organization (HMO) Medicare Risk
AM = Automobile Medical
BL = Blue Cross/Blue Shield
CH = Champus
CI=Commercial Insurance Co
DS= Disability
HM = Health Maintenance Organization
LI = Liability
LM = Liability Medical
MB= Medicare part B
MC = Medicaid
OF = Other Federal Program
TV= Title V
VA=Veteran Administration Plan Refers To Veterans Affairs Plan
WC = Workers' Compensation Health Claim
ZZ = Mutually Defined Unknown

Comment : Code to identify the type of claim.
You might also like:
•EMC - Loop 2000B - Element - SBR01, SBR02 and SBR 09
•LOOP 2430 IN EMC - Line Adjudication Information
•EMC - Loop 2330A Other Subscriber Name and Address
•EMC - Loop 2320 - Coordination of Benefits (COB) Payer Paid Amount and Allowed Amount.

re: EDI invalid : SBR05 required...

I broke it down to specificly to what your denail code is:


Usage : Required Element : SBR05 Value : AP = Auto Insurance Policy C1 = Commercial CP = Medicare Conditionally Primary GP = Group Policy HM = Health Maintenance Organization (HM0) IP = Individual Policy LD = Long Term Policy LT = Litigation MB = Medicare Part B MC = Medicaid MI = Medigap Part B MP = Medicare Primary OT = Other PP = Personal Payment (Cash - No Insurance) SP = Supplemental Policy

Comment : Code to identify the type of insurance policy within a specific insurance program.

re: EDI invalid : SBR05 required...

It means that Medicare is not the primary payer..