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.
HL7 Attribute Table - IN3 - Insurance Additional Information, Certification
RRequiredOOptionalCConditionalWWithdrawn|#Date/Time*Backward compat.+Filler
25
| C.Len | Element | v2.3.1 | FHIR | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | ..4 | - | SI | R | 1 | - | 00502 | IN3-1 | Set ID - IN3 | - | |
| 2 | ..250 | - | CX | O | 1 | - | 00503 | IN3-2 | Certification Number | Length | - |
| 3 | ..250 | - | XCN | O | * | - | 00504 | IN3-3 | Certified By | Length | - |
| 4 | ..1 | - | ID | O | 1 | 0136 | 00505 | IN3-4 | Certification Required | - | |
| 5 | ..10 | - | MOP | O | 1 | 0148 | 00506 | IN3-5 | Penalty | - | |
| 6 | ..26 | - | TS | O | 1 | - | 00507 | IN3-6 | Certification Date/Time | - | |
| 7 | ..26 | - | TS | O | 1 | - | 00508 | IN3-7 | Certification Modify Date/Time | - | |
| 8 | ..250 | - | XCN | O | * | - | 00509 | IN3-8 | Operator | Length | - |
| 9 | ..8 | - | DT | O | 1 | - | 00510 | IN3-9 | Certification Begin Date | - | |
| 10 | ..8 | - | DT | O | 1 | - | 00511 | IN3-10 | Certification End Date | - | |
| 11 | ..3 | - | DTN | O | 1 | 0149 | 00512 | IN3-11 | Days | - | |
| 12 | ..250 | - | CE_0233 | O | 1 | 0233 | 00513 | IN3-12 | Non-Concur Code/Description | Length | - |
| 13 | ..26 | - | TS | O | 1 | - | 00514 | IN3-13 | Non-Concur Effective Date/Time | - | |
| 14 | ..250 | - | XCN | O | * | 0010 | 00515 | IN3-14 | Physician Reviewer | Length | - |
| 15 | ..48 | - | ST | O | 1 | - | 00516 | IN3-15 | Certification Contact | - | |
| 16 | ..250 | - | XTN | O | * | - | 00517 | IN3-16 | Certification Contact Phone Number | Length | - |
| 17 | ..250 | - | CE_0345 | O | 1 | 0345 | 00518 | IN3-17 | Appeal Reason | Length | - |
| 18 | ..250 | - | CE_0346 | O | 1 | 0346 | 00519 | IN3-18 | Certification Agency | Length | - |
| 19 | ..250 | - | XTN | O | * | - | 00520 | IN3-19 | Certification Agency Phone Number | Length | - |
| 20 | ..40 | - | PCF | O | * | 0150 | 00521 | IN3-20 | Pre-Certification Req/Window | - | |
| 21 | ..48 | - | ST | O | 1 | - | 00522 | IN3-21 | Case Manager | 3 mappings | |
| 22 | ..8 | - | DT | O | 1 | - | 00523 | IN3-22 | Second Opinion Date | - | |
| 23 | ..1 | - | IS | O | 1 | 0151 | 00524 | IN3-23 | Second Opinion Status | - | |
| 24 | ..1 | - | IS | O | * | 0152 | 00525 | IN3-24 | Second Opinion Documentation Received | - | |
| 25 | ..250 | - | XCN | O | * | 0010 | 00526 | IN3-25 | Second Opinion Physician | Length | - |
24