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 | v2.2 | FHIR | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | ..4 | - | SI | R | 1 | - | 00426 | IN1-1 | Set ID - Insurance | Name | - |
| 2 | ..8 | - | CE_0072 | R | 1 | 0072 | 00368 | IN1-2 | Insurance Plan ID | 2 | identifier |
| 3 | ..59 | - | CX | R | * | - | 00428 | IN1-3 | Insurance Company ID | 4 | - |
| 4 | ..130 | - | XON | O | * | - | 00429 | IN1-4 | Insurance Company Name | 5 | payor[1](Organization) |
| 5 | ..106 | - | XAD | O | * | - | 00430 | IN1-5 | Insurance Company Address | 4 | payer[1](Organization.address) |
| 6 | ..48 | - | XPN | O | * | - | 00431 | IN1-6 | Insurance Co. Contact Ppers | 4 | - |
| 7 | ..40 | - | XTN | O | 3 | - | 00432 | IN1-7 | Insurance Co Phone Number | 3 | - |
| 8 | ..12 | - | ST | O | 1 | - | 00433 | IN1-8 | Group Number | 2 | - |
| 9 | ..130 | - | XON | O | * | - | 00434 | IN1-9 | Group Name | 5 | - |
| 10 | ..12 | - | CX | O | * | - | 00435 | IN1-10 | Insured's group employer ID | 3 | 3 mappings |
| 11 | ..130 | - | XON | O | * | - | 00436 | IN1-11 | Insured's Group Emp Name | 5 | 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 | 2 | - |
| 15 | ..3 | - | IS | O | 1 | 0086 | 00440 | IN1-15 | Plan Type | 4 | type |
| 16 | ..48 | - | XPN | O | * | - | 00441 | IN1-16 | Name of Insured | 4 | 2 mappings |
| 17 | ..2 | - | IS | 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 | 4 | - |
| 19 | ..106 | - | XAD | O | * | - | 00444 | IN1-19 | Insured's Address | 4 | - |
| 20 | ..2 | - | IS | O | 1 | 0135 | 00445 | IN1-20 | Assignment of Benefits | 3 | - |
| 21 | ..2 | - | IS | O | 1 | 0173 | 00446 | IN1-21 | Coordination of Benefits | 3 | - |
| 22 | ..2 | - | ST | O | 1 | - | 00447 | IN1-22 | Coord of Ben. Priority | 2 | - |
| 23 | ..2 | - | ID | O | 1 | 0136 | 00448 | IN1-23 | Notice of Admission Code | 2 | - |
| 24 | ..8 | - | DT | O | 1 | - | 00449 | IN1-24 | Notice of Admission Date | 2 | - |
| 25 | ..2 | - | ID | O | 1 | 0136 | 00450 | IN1-25 | Rpt of Eigibility Code | 4 | - |
| 26 | ..8 | - | DT | O | 1 | - | 00451 | IN1-26 | Rpt of Eligibility Date | 2 | - |
| 27 | ..2 | - | IS | O | 1 | 0093 | 00452 | IN1-27 | Release Information Code | 3 | - |
| 28 | ..15 | - | ST | O | 1 | - | 00453 | IN1-28 | Pre-Admit Cert (PAC) | 2 | - |
| 29 | ..26 | - | TS | O | 1 | - | 00454 | IN1-29 | Verification Date/Time | Name | - |
| 30 | ..60 | - | XPN | O | 1 | - | 00455 | IN1-30 | Verification By | 3 | - |
| 31 | ..2 | - | IS | O | 1 | 0098 | 00456 | IN1-31 | Type of Agreement Code | 3 | - |
| 32 | ..2 | - | IS | O | 1 | 0022 | 00457 | IN1-32 | Billing Status | 3 | - |
| 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 | Optionality | - |
| 35 | ..8 | - | IS | O | 1 | 0042 | 00460 | IN1-35 | Company Plan Code | 3 | - |
| 36 | ..15 | - | ST | O | 1 | - | 00461 | IN1-36 | Policy Number | 2 | - |
| 37 | ..12 | - | CP | O | 1 | - | 00462 | IN1-37 | Policy Deductible | 3 | - |
| 38 | ..12 | - | CP | B | 1 | - | 00463 | IN1-38 | Policy Limit - Amount | 3 | - |
| 39 | ..4 | - | NM | O | 1 | - | 00464 | IN1-39 | Policy Limit - Days | 2 | - |
| 40 | ..12 | - | CP | B | 1 | - | 00465 | IN1-40 | Room Rate - Semi-Private | 3 | - |
| 41 | ..12 | - | CP | B | 1 | - | 00466 | IN1-41 | Room Rate - Private | 3 | - |
| 42 | ..60 | - | CE_0066 | O | 1 | 0066 | 00467 | IN1-42 | Insured's Employment Status | 2 | - |
| 43 | ..1 | - | IS | O | 1 | 0001 | 00468 | IN1-43 | Insured's Sex | 3 | - |
| 44 | ..106 | - | XAD | O | * | - | 00469 | IN1-44 | Insured's Employer Address | 4 | - |
| 45 | ..2 | - | ST | O | 1 | - | 00470 | IN1-45 | Verification Status | 2 | - |
| 46 | ..8 | - | IS | O | 1 | 0072 | 00471 | IN1-46 | Prior Insurance Plan ID | 3 | - |
| 47 | ..3 | - | IS | O | 1 | 0309 | 01277 | IN1-47 | Coverage Type | NEW | - |
| 48 | ..2 | - | IS | O | 1 | 0295 | 00753 | IN1-48 | Handicap | NEW | - |
| 49 | ..12 | - | CX | O | * | - | 01230 | IN1-49 | Insured's ID Number | NEW | 2 mappings |
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