IN2

Insurance Additional Information

...

2.2Nov1994

2.3Apr1997

2.3.1May1999

...

The IN2 segment contains additional insurance policy coverage and benefit information necessary for proper billing and reimbursement. Fields used by this segment are defined by HCFA or other regulatory agencies.

Figure 6-7. IN2 attributes

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

		C.Len						Element		v2.2
1	..59	-	CX	O	*	-	00472	IN2-1	Insured's Employee ID	5
2	..11	-	ST	O	1	-	00473	IN2-2	Insured's Social Security Number	3
3	..130	-	XCN	O	*	-	00474	IN2-3	Insured's Employer Name	5
4	..1	-	IS	O	1	0139	00475	IN2-4	Employer Information Data	3
5	..1	-	IS	O	*	0137	00476	IN2-5	Mail Claim Party	4
6	..15	-	ST	O	1	-	00477	IN2-6	Medicare Health Ins Card Number	3
7	..48	-	XPN	O	*	-	00478	IN2-7	Medicaid Case Name	4
8	..15	-	ST	O	1	-	00479	IN2-8	Medicaid Case Number	3
9	..48	-	XPN	O	*	-	00480	IN2-9	Champus Sponsor Name	4
10	..20	-	ST	O	1	-	00481	IN2-10	Champus ID Number	3
11	..80	-	CE	O	1	-	00482	IN2-11	Dependent of Champus Recipient	4
12	..25	-	ST	O	1	-	00483	IN2-12	Champus Organization	2
13	..25	-	ST	O	1	-	00484	IN2-13	Champus Station	2
14	..14	-	IS	O	1	0140	00485	IN2-14	Champus Service	3
15	..2	-	IS	O	1	0141	00486	IN2-15	Champus Rank/Grade	3
16	..3	-	IS	O	1	0142	00487	IN2-16	Champus Status	3
17	..8	-	DT	O	1	-	00488	IN2-17	Champus Retire Date	2
18	..1	-	ID	O	1	0136	00489	IN2-18	Champus Non-Avail Cert on File	2
19	..1	-	ID	O	1	0136	00490	IN2-19	Baby Coverage	2
20	..1	-	ID	O	1	0136	00491	IN2-20	Combine Baby Bill	2
21	..1	-	ST	O	1	-	00492	IN2-21	Blood Deductible	3
22	..48	-	XPN	O	*	-	00493	IN2-22	Special Coverage Approval Name	4
23	..30	-	ST	O	1	-	00494	IN2-23	Special Coverage Approval Title	2
24	..8	-	ST	O	*	0143	00495	IN2-24	Non-Covered Insurance Code	3
25	..59	-	CX	O	*	-	00496	IN2-25	Payor ID	4
26	..59	-	CX	O	*	-	00497	IN2-26	Payor Subscriber ID	5
27	..1	-	IS	O	1	0144	00498	IN2-27	Eligibility Source	3
28	..25	-	CM_RMC	O	*	-	00499	IN2-28	Room Coverage Type/Amount	3
29	..25	-	CM_PTA	O	*	-	00500	IN2-29	Policy Type/Amount	3
30	..25	-	CM_DDI	O	1	-	00501	IN2-30	Daily Deductible	2
31	..2	-	IS	O	1	0223	00755	IN2-31	Living Dependency	NEW
32	..2	-	IS	O	1	0009	00145	IN2-32	Ambulatory Status	NEW
33	..4	-	IS	O	1	0171	00129	IN2-33	Citizenship	NEW
34	..60	-	CE_0296	O	1	0296	00118	IN2-34	Primary Language	NEW
35	..2	-	IS	O	1	0220	00742	IN2-35	Living Arrangement	NEW
36	..1	-	CE_0215	O	1	0215	00743	IN2-36	Publicity Indicator	NEW
37	..1	-	ID	O	1	0136	00744	IN2-37	Protection Indicator	NEW
38	..2	-	IS	O	1	0231	00745	IN2-38	Student Indicator	NEW
39	..3	-	IS	O	1	0006	00120	IN2-39	Religion	NEW
40	..48	-	XPN	O	1	-	00746	IN2-40	Mother’s Maiden Name	NEW
41	..80	-	CE_0212	O	1	0212	00739	IN2-41	Nationality Code	NEW
42	..1	-	IS	O	1	0189	00125	IN2-42	Ethnic Group	NEW
43	..1	-	IS	O	*	0002	00119	IN2-43	Marital Status	NEW
44	..8	-	DT	O	1	-	00787	IN2-44	Employment Start Date	NEW
45	..8	-	DT	O	1	-	00783	IN2-45	Employment Stop Date	NEW
46	..20	-	ST	O	1	-	00785	IN2-46	Job Title	NEW
47	..20	-	JCC	O	1	-	00786	IN2-47	Job Code/Class	NEW
48	..2	-	IS	O	1	0311	00752	IN2-48	Job Status	NEW
49	..48	-	XPN	O	*	-	00789	IN2-49	Employer Contact Person Name	NEW
50	..40	-	XTN	O	*	-	00790	IN2-50	Employer Contact Person Phone Number	NEW
51	..2	-	IS	O	1	0222	00791	IN2-51	Employer Contact Reason	NEW
52	..48	-	XPN	O	*	-	00792	IN2-52	Insured’s Contact Person’s Name	NEW
53	..40	-	XTN	O	*	-	00793	IN2-53	Insured’s Contact Person Telephone Number	NEW
54	..2	-	IS	O	*	0222	00794	IN2-54	Insured’s Contact Person Reason	NEW
55	..8	-	DT	O	1	-	00795	IN2-55	Relationship To The Patient Start Date	NEW
56	..8	-	DT	O	*	-	00796	IN2-56	Relationship To The Patient Stop Date	NEW
57	..2	-	IS	O	1	0232	00797	IN2-57	Insurance Co. Contact Reason	NEW
58	..40	-	XTN	O	1	-	00798	IN2-58	Insurance Co. Contact Phone Number	NEW
59	..2	-	IS	O	1	0312	00799	IN2-59	Policy Scope	NEW
60	..2	-	IS	O	1	0313	00800	IN2-60	Policy Source	NEW
61	..60	-	CX	O	1	-	00801	IN2-61	Patient Member Number	NEW
62	..2	-	IS	O	1	0063	00802	IN2-62	Guarantor’s Relationship To Insured	NEW
63	..40	-	XTN	O	*	-	00803	IN2-63	Insured’s Telephone Number - Home	NEW
64	..40	-	XTN	O	*	-	00804	IN2-64	Insured’s Employer Telephone Number	NEW
65	..2	-	CE	O	1	-	00805	IN2-65	Military Handicapped Program	NEW
66	..2	-	ID	O	1	0136	00806	IN2-66	Suspend Flag	NEW
67	..2	-	ID	O	1	0136	00807	IN2-67	Co-pay Limit Flag	NEW
68	..2	-	ID	O	1	0136	00808	IN2-68	Stoploss Limit Flag	NEW
69	..130	-	XON	O	*	-	00809	IN2-69	Insured Organization Name And ID	NEW
70	..130	-	XON	O	*	-	00810	IN2-70	Insured Employer Organization Name And ID	NEW
71	..1	-	IS	O	1	0005	00113	IN2-71	Race	NEW
72	..1	-	ID	O	1	-	00811	IN2-72	Patient Relationship to Insured	NEW