11 December, 2014

IN3 - HL7 Segment Reference

IN3 - Insurance Additional Information, Certification Segment.

The IN3 segment contains additional insurance information for certifying the need for patient care.  Fields used by this segment are defined by HCFA, or other regulatory agencies. HL7 Attribute Table - IN3 – Insurance Additional Information, Certification.
SEQ
LEN
DT
ITEM#
ELEMENT NAME
1
4
SI
00502
Set ID - IN3
2
250
CX
00503
Certification Number
3
250
XCN
00504
Certified By
4
1
ID
00505
Certification Required
5
10
CM
00506
Penalty
6
26
TS
00507
Certification Date/Time
7
26
TS
00508
Certification Modify Date/Time
8
250
XCN
00509
Operator
9
8
DT
00510
Certification Begin Date
10
8
DT
00511
Certification End Date
11
3
CM
00512
Days
12
250
CE
00513
Non-Concur Code/Description
13
26
TS
00514
Non-Concur Effective Date/Time
14
250
XCN
00515
Physician Reviewer
15
48
ST
00516
Certification Contact
16
250
XTN
00517
Certification Contact Phone Number
17
250
CE
00518
Appeal Reason
18
250
CE
00519
Certification Agency
19
250
XTN
00520
Certification Agency Phone Number
20
40
CM
00521
Pre-Certification Req/Window
21
48
ST
00522
Case Manager
22
8
DT
00523
Second Opinion Date
23
1
IS
00524
Second Opinion Status
24
1
IS
00525
Second Opinion Documentation Received
25
250
XCN
00526
Second Opinion Physician

IN2 - HL7 Segment Reference

IN2 - Insurance Additional Information Segment.

The IN2 segment contains additional insurance policy coverage and benefit information necessary for proper billing and reimbursement.  Fields used by this segment are defined by HCFA or other regulatory agencies.HL7 Attribute Table - IN2 – Insurance Additional Information.
SEQ
LEN
DT
ITEM#
ELEMENT NAME
1
250
CX
00472
Insured’s Employee ID
2
11
ST
00473
Insured’s Social Security Number
3
250
XCN
00474
Insured’s Employer’s Name and ID
4
1
IS
00475
Employer Information Data
5
1
IS
00476
Mail Claim Party
6
15
ST
00477
Medicare Health Ins Card Number
7
250
XPN
00478
Medicaid Case Name
8
15
ST
00479
Medicaid Case Number
9
250
XPN
00480
Military Sponsor Name
10
20
ST
00481
Military ID Number
11
250
CE
00482
Dependent Of Military Recipient
12
25
ST
00483
Military Organization
13
25
ST
00484
Military Station
14
14
IS
00485
Military Service
15
2
IS
00486
Military Rank/Grade
16
3
IS
00487
Military Status
17
8
DT
00488
Military Retire Date
18
1
ID
00489
Military Non-Avail Cert On File
19
1
ID
00490
Baby Coverage
20
1
ID
00491
Combine Baby Bill
21
1
ST
00492
Blood Deductible
22
250
XPN
00493
Special Coverage Approval Name
23
30
ST
00494
Special Coverage Approval Title
24
8
IS
00495
Non-Covered Insurance Code
25
250
CX
00496
Payor ID
26
250
CX
00497
Payor Subscriber ID
27
1
IS
00498
Eligibility Source
28
250
CM
00499
Room Coverage Type/Amount
29
250
CM
00500
Policy Type/Amount
30
250
CM
00501
Daily Deductible
31
2
IS
00755
Living Dependency
32
2
IS
00145
Ambulatory Status
33
250
CE
00129
Citizenship
34
250
CE
00118
Primary Language
35
2
IS
00742
Living Arrangement
36
250
CE
00743
Publicity Code
37
1
ID
00744
Protection Indicator
38
2
IS
00745
Student Indicator
39
250
CE
00120
Religion
40
250
XPN
00109
Mother’s Maiden Name
41
250
CE
00739
Nationality
42
250
CE
00125
Ethnic Group
43
250
CE
00119
Marital Status
44
8
DT
00787
Insured’s Employment Start Date
45
8
DT
00783
Employment Stop Date
46
20
ST
00785
Job Title
47
20
JCC
00786
Job Code/Class
48
2
IS
00752
Job Status
49
250
XPN
00789
Employer Contact Person Name
50
250
XTN
00790
Employer Contact Person Phone Number
51
2
IS
00791
Employer Contact Reason
52
250
XPN
00792
Insured’s Contact Person’s Name
53
250
XTN
00793
Insured’s Contact Person Phone Number
54
2
IS
00794
Insured’s Contact Person Reason
55
8
DT
00795
Relationship To The Patient Start Date
56
8
DT
00796
Relationship To The Patient Stop Date
57
2
IS
00797
Insurance Co. Contact Reason
58
250
XTN
00798
Insurance Co Contact Phone Number
59
2
IS
00799
Policy Scope
60
2
IS
00800
Policy Source
61
250
CX
00801
Patient Member Number
62
250
CE
00802
Guarantor’s Relationship To Insured
63
250
XTN
00803
Insured’s Phone Number - Home
64
250
XTN
00804
Insured’s Employer Phone Number
65
250
CE
00805
Military Handicapped Program
66
1
ID
00806
Suspend Flag
67
1
ID
00807
Copay Limit Flag
68
1
ID
00808
Stoploss Limit Flag
69
250
XON
00809
Insured Organization Name And ID
70
250
XON
00810
Insured Employer Organization Name And ID
71
250
CE
00113
Race
72
250
CE
00811
HCFA Patient’s Relationship to Insured