IN1
INSURANCE
FHIR:Coverage
The IN1 segment contains insurance policy coverage information necessary to produce properly pro-rated and patient and insurance bills.
FIELD NOTES: IN1 INSURANCE
RRequiredOOptionalCConditionalWWithdrawn|#Date/Time*Backward compat.+Filler
44
| C.Len | Element | FHIR | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| 1 | ..4 | - | SI | R | 1 | - | 00234 | IN1-1 | SET ID - INSURANCE | - |
| 2 | ..8 | - | ID | R | 1 | 0072 | 00378 | IN1-2 | INSURANCE PLAN ID | identifier |
| 3 | ..6 | - | ST | R | 1 | - | 00235 | IN1-3 | INSURANCE COMPANY ID | - |
| 4 | ..45 | - | ST | O | 1 | - | 00236 | IN1-4 | INSURANCE COMPANY NAME | payor[1](Organization) |
| 5 | ..106 | - | AD | O | 1 | - | 00237 | IN1-5 | INSURANCE COMPANY ADDRESS | payer[1](Organization.address) |
| 6 | ..48 | - | PN | O | 1 | - | 00242 | IN1-6 | INSURANCE CO. CONTACT PERS | - |
| 7 | ..40 | - | TN | O | 1 | - | 00243 | IN1-7 | INSURANCE CO PHONE NUMBER | - |
| 8 | ..12 | - | ST | O | 1 | - | 00248 | IN1-8 | GROUP NUMBER | - |
| 9 | ..35 | - | ST | O | 1 | - | 00249 | IN1-9 | GROUP NAME | - |
| 10 | ..12 | - | ST | O | 1 | - | 00250 | IN1-10 | INSURED'S GROUP EMP. ID | 3 mappings |
| 11 | ..45 | - | ST | O | 1 | - | 00251 | IN1-11 | INSURED'S GROUP EMP. NAME | policyHolder[1](Organization) |
| 12 | ..8 | - | DT | O | 1 | - | 00252 | IN1-12 | PLAN EFFECTIVE DATE | period.start |
| 13 | ..8 | - | DT | O | 1 | - | 00253 | IN1-13 | PLAN EXPIRATION DATE | period.end |
| 14 | ..55 | - | ST | O | 1 | - | 00254 | IN1-14 | AUTHORIZATION INFORMATION | - |
| 15 | ..2 | - | ID | O | 1 | 0086 | 00260 | IN1-15 | PLAN TYPE | type |
| 16 | ..48 | - | PN | O | 1 | - | 00261 | IN1-16 | NAME OF INSURED | 2 mappings |
| 17 | ..2 | - | ID | O | 1 | 0063 | 00262 | IN1-17 | INSURED'S RELATIONSHIP TO PATIENT | relationship |
| 18 | ..8 | - | DT | O | 1 | - | 00708 | IN1-18 | INSURED'S DATE OF BIRTH | - |
| 19 | ..106 | - | AD | O | 1 | - | 00709 | IN1-19 | INSURED'S ADDRESS | - |
| 20 | ..2 | - | ID | O | 1 | - | 00263 | IN1-20 | ASSIGNMENT OF BENEFITS | - |
| 21 | ..2 | - | ID | O | 1 | - | 00264 | IN1-21 | COORDINATION OF BENEFITS | - |
| 22 | ..2 | - | ST | O | 1 | - | 00265 | IN1-22 | COORD OF BEN. PRIORITY | - |
| 23 | ..2 | - | ID | O | 1 | 0081 | 00266 | IN1-23 | NOTICE OF ADMISSION CODE | - |
| 24 | ..8 | - | DT | O | 1 | - | 00267 | IN1-24 | NOTICE OF ADMISSION DATE | - |
| 25 | ..2 | - | ID | O | 1 | 0094 | 00268 | IN1-25 | RPT OF ELIGIBILITY CODE | - |
| 26 | ..8 | - | DT | O | 1 | - | 00269 | IN1-26 | RPT OF ELIGIBILITY DATE | - |
| 27 | ..2 | - | ID | O | 1 | 0093 | 00270 | IN1-27 | RELEASE INFORMATION CODE | - |
| 28 | ..15 | - | ST | O | 1 | - | 00271 | IN1-28 | PRE-ADMIT CERT. (PAC) | - |
| 29 | ..8 | - | DT | O | 1 | - | 00272 | IN1-29 | VERIFICATION DATE | - |
| 30 | ..60 | - | CM | O | 1 | - | 00273 | IN1-30 | VERIFICATION BY | - |
| 31 | ..2 | - | ID | O | 1 | 0098 | 00277 | IN1-31 | TYPE OF AGREEMENT CODE | - |
| 32 | ..2 | - | ID | O | 1 | 0022 | 00278 | IN1-32 | BILLING STATUS | - |
| 33 | ..4 | - | NM | O | 1 | - | 00280 | IN1-33 | LIFETIME RESERVE DAYS | - |
| 34 | ..4 | - | NM | O | 1 | - | 00281 | IN1-34 | DELAY BEFORE L. R. DAY | - |
| 35 | ..8 | - | ST | O | 1 | 0042 | 00282 | IN1-35 | COMPANY PLAN CODE | - |
| 36 | ..15 | - | ST | O | 1 | - | 00283 | IN1-36 | POLICY NUMBER | - |
| 37 | ..12 | - | NM | O | 1 | - | 00284 | IN1-37 | POLICY DEDUCTIBLE | - |
| 38 | ..12 | - | NM | O | 1 | - | 00285 | IN1-38 | POLICY LIMIT - AMOUNT | - |
| 39 | ..4 | - | NM | O | 1 | - | 00286 | IN1-39 | POLICY LIMIT - DAYS | - |
| 40 | ..12 | - | NM | O | 1 | - | 00287 | IN1-40 | ROOM RATE - SEMI-PRIVATE | - |
| 41 | ..12 | - | NM | O | 1 | - | 00288 | IN1-41 | ROOM RATE - PRIVATE | - |
| 42 | ..1 | - | ID | O | 1 | 0066 | 00710 | IN1-42 | INSURED'S EMPLOYMENT STATUS | - |
| 43 | ..1 | - | ID | O | 1 | 0001 | 00711 | IN1-43 | INSURED'S SEX | - |
| 44 | ..106 | - | AD | O | 1 | - | 00713 | IN1-44 | INSURED'S EMPLOYER ADDRESS | - |
Used In Message Structures