IN1
Insurance
FHIR:Coverage
The IN1 segment contains insurance policy coverage information necessary to produce properly pro-rated and patient and insurance bills.
Figure 6-6. IN1 attributes
RRequiredOOptionalCConditionalWWithdrawn|#Date/Time*Backward compat.+Filler
49
| C.Len | Element | v2.3 | FHIR | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | ..4 | - | SI | R | 1 | - | 00426 | IN1-1 | Set ID - IN1 | Name | - |
| 2 | ..60 | - | CE_0072 | R | 1 | 0072 | 00368 | IN1-2 | Insurance Plan ID | Length | identifier |
| 3 | ..59 | - | CX | R | * | - | 00428 | IN1-3 | Insurance Company ID | - | |
| 4 | ..130 | - | XON | O | * | - | 00429 | IN1-4 | Insurance Company Name | payor[1](Organization) | |
| 5 | ..106 | - | XAD | O | * | - | 00430 | IN1-5 | Insurance Company Address | payer[1](Organization.address) | |
| 6 | ..48 | - | XPN | O | * | - | 00431 | IN1-6 | Insurance Co Contact Person | Name | - |
| 7 | ..40 | - | XTN | O | * | - | 00432 | IN1-7 | Insurance Co Phone Number | Repetition | - |
| 8 | ..12 | - | ST | O | 1 | - | 00433 | IN1-8 | Group Number | - | |
| 9 | ..130 | - | XON | O | * | - | 00434 | IN1-9 | Group Name | - | |
| 10 | ..12 | - | CX | O | * | - | 00435 | IN1-10 | Insured’s Group Emp ID | Name | 3 mappings |
| 11 | ..130 | - | XON | O | * | - | 00436 | IN1-11 | Insured’s Group Emp Name | Name | policyHolder[1](Organization) |
| 12 | ..8 | - | DT | O | 1 | - | 00437 | IN1-12 | Plan Effective Date | period.start | |
| 13 | ..8 | - | DT | O | 1 | - | 00438 | IN1-13 | Plan Expiration Date | period.end | |
| 14 | ..55 | - | AUI | O | 1 | - | 00439 | IN1-14 | Authorization Information | Data Type | - |
| 15 | ..3 | - | IS | O | 1 | 0086 | 00440 | IN1-15 | Plan Type | type | |
| 16 | ..48 | - | XPN | O | * | - | 00441 | IN1-16 | Name Of Insured | Name | 2 mappings |
| 17 | ..80 | - | CE_0063 | O | 1 | 0063 | 00442 | IN1-17 | Insured’s Relationship To Patient | 3 | relationship |
| 18 | ..26 | - | TS | O | 1 | - | 00443 | IN1-18 | Insured’s Date Of Birth | Name | - |
| 19 | ..106 | - | XAD | O | * | - | 00444 | IN1-19 | Insured’s Address | Name | - |
| 20 | ..2 | - | IS | O | 1 | 0135 | 00445 | IN1-20 | Assignment Of Benefits | Name | - |
| 21 | ..2 | - | IS | O | 1 | 0173 | 00446 | IN1-21 | Coordination Of Benefits | Name | - |
| 22 | ..2 | - | ST | O | 1 | - | 00447 | IN1-22 | Coord Of Ben. Priority | Name | - |
| 23 | ..1 | - | ID | O | 1 | 0136 | 00448 | IN1-23 | Notice Of Admission Flag | 2 | - |
| 24 | ..8 | - | DT | O | 1 | - | 00449 | IN1-24 | Notice Of Admission Date | Name | - |
| 25 | ..1 | - | ID | O | 1 | 0136 | 00450 | IN1-25 | Report Of Eligibility Flag | 2 | - |
| 26 | ..8 | - | DT | O | 1 | - | 00451 | IN1-26 | Report Of Eligibility Date | Name | - |
| 27 | ..2 | - | IS | O | 1 | 0093 | 00452 | IN1-27 | Release Information Code | - | |
| 28 | ..15 | - | ST | O | 1 | - | 00453 | IN1-28 | Pre-Admit Cert (PAC) | - | |
| 29 | ..26 | - | TS | O | 1 | - | 00454 | IN1-29 | Verification Date/Time | Optionality | - |
| 30 | ..60 | - | XCN | O | * | - | 00455 | IN1-30 | Verification By | 2 | - |
| 31 | ..2 | - | IS | O | 1 | 0098 | 00456 | IN1-31 | Type Of Agreement Code | Name | - |
| 32 | ..2 | - | IS | O | 1 | 0022 | 00457 | IN1-32 | Billing Status | - | |
| 33 | ..4 | - | NM | O | 1 | - | 00458 | IN1-33 | Lifetime Reserve Days | - | |
| 34 | ..4 | - | NM | O | 1 | - | 00459 | IN1-34 | Delay Before L.R. Day | Name | - |
| 35 | ..8 | - | IS | O | 1 | 0042 | 00460 | IN1-35 | Company Plan Code | - | |
| 36 | ..15 | - | ST | O | 1 | - | 00461 | IN1-36 | Policy Number | - | |
| 37 | ..12 | - | CP | O | 1 | - | 00462 | IN1-37 | Policy Deductible | - | |
| 38 | ..12 | - | CP | B | 1 | - | 00463 | IN1-38 | Policy Limit - Amount | - | |
| 39 | ..4 | - | NM | O | 1 | - | 00464 | IN1-39 | Policy Limit - Days | - | |
| 40 | ..12 | - | CP | B | 1 | - | 00465 | IN1-40 | Room Rate - Semi-Private | - | |
| 41 | ..12 | - | CP | B | 1 | - | 00466 | IN1-41 | Room Rate - Private | - | |
| 42 | ..60 | - | CE_0066 | O | 1 | 0066 | 00467 | IN1-42 | Insured’s Employment Status | Name | - |
| 43 | ..1 | - | IS | O | 1 | 0001 | 00468 | IN1-43 | Insured’s Sex | Name | - |
| 44 | ..106 | - | XAD | O | * | - | 00469 | IN1-44 | Insured’s Employer’s Address | Name | - |
| 45 | ..2 | - | ST | O | 1 | - | 00470 | IN1-45 | Verification Status | - | |
| 46 | ..8 | - | IS | O | 1 | 0072 | 00471 | IN1-46 | Prior Insurance Plan ID | - | |
| 47 | ..3 | - | IS | O | 1 | 0309 | 01227 | IN1-47 | Coverage Type | - | |
| 48 | ..2 | - | IS | O | 1 | 0295 | 00753 | IN1-48 | Handicap | - | |
| 49 | ..12 | - | CX | O | * | - | 01230 | IN1-49 | Insured’s ID Number | Name | 2 mappings |
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