IN1

INSURANCE

2.1Dec1992

2.2Nov1994

2.3Apr1997

...

The IN1 segment contains insurance policy coverage information necessary to produce properly pro-rated and patient and insurance bills.

Figure 6-5 IN1 attributes

RRequiredOOptionalCConditionalWWithdrawn|#Date/Time*Backward compat.+Filler

		C.Len						Element		v2.1	FHIR
1	..4	-	SI	R	1	-	00426	IN1-1	Set ID - insurance	Name	-
2	..8	-	ID	R	1	0072	00368	IN1-2	Insurance plan ID	Name	identifier
3	..9	-	ST	R	1	-	00428	IN1-3	Insurance company ID	2	-
4	..45	-	ST	O	1	-	00429	IN1-4	Insurance company name	2	payor[1](Organization)
5	..106	-	AD	O	1	-	00430	IN1-5	Insurance company address	2	payer[1](Organization.address)
6	..48	-	PN	O	1	-	00431	IN1-6	Insurance company contact pers	2	-
7	..40	-	TN	O	3	-	00432	IN1-7	Insurance company phone number	3	-
8	..12	-	ST	O	1	-	00433	IN1-8	Group number	2	-
9	..35	-	ST	O	1	-	00434	IN1-9	Group name	2	-
10	..12	-	ST	O	1	-	00435	IN1-10	Insured's group employer ID	2	3 mappings
11	..45	-	ST	O	1	-	00436	IN1-11	Insured's group employer name	2	policyHolder[1](Organization)
12	..8	-	DT	O	1	-	00437	IN1-12	Plan effective date	2	period.start
13	..8	-	DT	O	1	-	00438	IN1-13	Plan expiration date	2	period.end
14	..55	-	CM_AUI	O	1	-	00439	IN1-14	Authorization information	3	-
15	..5	-	ID	O	1	0086	00440	IN1-15	Plan type	3	type
16	..48	-	PN	O	1	-	00441	IN1-16	Name of insured	2	2 mappings
17	..2	-	ID	O	1	0063	00442	IN1-17	Insured's relationship to patient	2	relationship
18	..8	-	DT	O	1	-	00443	IN1-18	Insured's date of birth	2	-
19	..106	-	AD	O	1	-	00444	IN1-19	Insured's address	2	-
20	..2	-	ID	O	1	0135	00445	IN1-20	Assignment of benefits	3	-
21	..2	-	ID	O	1	0173	00446	IN1-21	Coordination of benefits	3	-
22	..2	-	ST	O	1	-	00447	IN1-22	Coordination of benefits - priority	2	-
23	..2	-	ID	O	1	0136	00448	IN1-23	Notice of admission code	3	-
24	..8	-	DT	O	1	-	00449	IN1-24	Notice of admission date	2	-
25	..4	-	ID	O	1	-	00450	IN1-25	Report of eligibility code	4	-
26	..8	-	DT	O	1	-	00451	IN1-26	Report of eligibility date	2	-
27	..2	-	ID	O	1	0093	00452	IN1-27	Release information code	2	-
28	..15	-	ST	O	1	-	00453	IN1-28	Pre-admit certification (PAC)	2	-
29	..26	-	TS	O	1	-	00454	IN1-29	Verification date / time	4	-
30	..60	-	CN_PERSON	O	1	-	00455	IN1-30	Verification by	3	-
31	..2	-	ID	O	1	0098	00456	IN1-31	Type of agreement code	2	-
32	..2	-	ID	O	1	0022	00457	IN1-32	Billing status	2	-
33	..4	-	NM	O	1	-	00458	IN1-33	Lifetime reserve days	2	-
34	..4	-	NM	O	1	-	00459	IN1-34	Delay before lifetime reserve days	2	-
35	..8	-	ID	O	1	0042	00460	IN1-35	Company plan code	3	-
36	..15	-	ST	O	1	-	00461	IN1-36	Policy number	2	-
37	..12	-	NM	O	1	-	00462	IN1-37	Policy deductible	2	-
38	..12	-	NM	O	1	-	00463	IN1-38	Policy limit - amount	2	-
39	..4	-	NM	O	1	-	00464	IN1-39	Policy limit - days	2	-
40	..12	-	NM	O	1	-	00465	IN1-40	Room rate - semi-private	2	-
41	..12	-	NM	O	1	-	00466	IN1-41	Room rate - private	2	-
42	..60	-	CE_0066	O	1	0066	00467	IN1-42	Insured's employment status	4	-
43	..1	-	ID	O	1	0001	00468	IN1-43	Insured's sex	2	-
44	..106	-	AD	O	1	-	00469	IN1-44	Insured's employer address	2	-
45	..2	-	ST	O	1	-	00470	IN1-45	Verification status	NEW	-
46	..8	-	ID	O	1	0072	00471	IN1-46	Prior insurance plan ID	NEW	-

Editorial Comments for IN12

Field 42

compare with GT1-20

BSW

Field 17

compare with GT1-11, NK1-3

BSW