IN3
Insurance Additional Information, Certification
FHIR:Careteam
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.
Figure 6-8. IN3 attributes
RRequiredOOptionalCConditionalWWithdrawn|#Date/Time*Backward compat.+Filler
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| C.Len | Element | v2.3 | FHIR | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | ..4 | - | SI | R | 1 | - | 00502 | IN3-1 | Set ID - IN3 | Name | - |
| 2 | ..59 | - | CX | O | 1 | - | 00503 | IN3-2 | Certification Number | - | |
| 3 | ..60 | - | XCN | O | * | - | 00504 | IN3-3 | Certified By | - | |
| 4 | ..1 | - | ID | O | 1 | 0136 | 00505 | IN3-4 | Certification Required | - | |
| 5 | ..10 | - | MOP | O | 1 | 0148 | 00506 | IN3-5 | Penalty | Data Type | - |
| 6 | ..26 | - | TS | O | 1 | - | 00507 | IN3-6 | Certification Date/Time | - | |
| 7 | ..26 | - | TS | O | 1 | - | 00508 | IN3-7 | Certification Modify Date/Time | Optionality | - |
| 8 | ..60 | - | XCN | O | * | - | 00509 | IN3-8 | Operator | Optionality | - |
| 9 | ..8 | - | DT | O | 1 | - | 00510 | IN3-9 | Certification Begin Date | Optionality | - |
| 10 | ..8 | - | DT | O | 1 | - | 00511 | IN3-10 | Certification End Date | Optionality | - |
| 11 | ..3 | - | DTN | O | 1 | 0149 | 00512 | IN3-11 | Days | 2 | - |
| 12 | ..60 | - | CE_0233 | O | 1 | 0233 | 00513 | IN3-12 | Non-Concur Code/Description | Optionality | - |
| 13 | ..26 | - | TS | O | 1 | - | 00514 | IN3-13 | Non-Concur Effective Date/Time | Optionality | - |
| 14 | ..60 | - | XCN | O | * | 0010 | 00515 | IN3-14 | Physician Reviewer | 2 | - |
| 15 | ..48 | - | ST | O | 1 | - | 00516 | IN3-15 | Certification Contact | Optionality | - |
| 16 | ..40 | - | XTN | O | * | - | 00517 | IN3-16 | Certification Contact Phone Number | Optionality | - |
| 17 | ..60 | - | CE_0345 | O | 1 | 0345 | 00518 | IN3-17 | Appeal Reason | 3 | - |
| 18 | ..60 | - | CE_0346 | O | 1 | 0346 | 00519 | IN3-18 | Certification Agency | 3 | - |
| 19 | ..40 | - | XTN | O | * | - | 00520 | IN3-19 | Certification Agency Phone Number | Optionality | - |
| 20 | ..40 | - | PCF | O | * | 0150 | 00521 | IN3-20 | Pre-Certification Req/Window | 4 | - |
| 21 | ..48 | - | ST | O | 1 | - | 00522 | IN3-21 | Case Manager | Optionality | 3 mappings |
| 22 | ..8 | - | DT | O | 1 | - | 00523 | IN3-22 | Second Opinion Date | Optionality | - |
| 23 | ..1 | - | IS | O | 1 | 0151 | 00524 | IN3-23 | Second Opinion Status | Optionality | - |
| 24 | ..1 | - | IS | O | * | 0152 | 00525 | IN3-24 | Second Opinion Documentation Received | Optionality | - |
| 25 | ..60 | - | XCN | O | * | 0010 | 00526 | IN3-25 | Second Opinion Physician | 2 | - |
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