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