Source of Payment Code
X12N Information
Loop ID 2000B
Segment ID SBR
Position in Segment 09
837I Information This field also exists in the ASC X12N Health Care Claim: Institutional
External Codes This field does not use a code list external to the ASC X12 Standard
If applicable, all internal X12 codes follow
09 - Self-pay
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
17 - Dental Maintenance Organization
AM - Automobile Medical
BL - Blue Cross/Blue Shield
CH - Champus
CI - Commercial Insurance Co.
DS - Disability
FI - Federal Employees Program
HM - Health Maintenance Organization
LM - Liability Medical
MA - Medicare Part A
MB - Medicare Part B
MC - Medicaid
OF - Other Federal Program
TV - Title V
VA - Veterans Affairs Plan
WC - Workers' Compensation Health Claim
ZZ - Mutually Defined
UB Information
None
There are no UB codes for this element.
HL7 C-CDA R1.1, CCD Document
Data Element Name Source of Payment Code
CCD Templated Path StructuredBody.component.Payers.CoverageActivity.entryRelationship.sequenceNumber
xPath ​/hl7:ClinicalDocument​/hl7:component​/hl7:structuredBody​/hl7:component​/hl7:section[hl7:code[@code="48768‑6"] and @codeSystem='2.16.840.1.113883.6.1']]​/hl7:entry​/hl7:act​/hl7:entryRelationship​/hl7:sequenceNumber
Additional Information
NCVHS This field has a cross reference to the National Committee on Vital and Health Statistics Core Data Set
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