IN2

Insurance Additional Information

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2.5Aug2003

2.5.1May2007

2.6Sep2007

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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 CMS or other regulatory agencies.

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

		C.Len						Element		v2.5
1	..250	-	CX	O	*	-	00472	IN2-1	Insured's Employee ID
2	..11	-	ST	O	1	-	00473	IN2-2	Insured's Social Security Number
3	..250	-	XCN	O	*	-	00474	IN2-3	Insured's Employer's Name and ID
4	..1	-	IS	O	1	0139	00475	IN2-4	Employer Information Data
5	..1	-	IS	O	*	0137	00476	IN2-5	Mail Claim Party
6	..15	-	ST	O	1	-	00477	IN2-6	Medicare Health Ins Card Number
7	..250	-	XPN	O	*	-	00478	IN2-7	Medicaid Case Name
8	..15	-	ST	O	1	-	00479	IN2-8	Medicaid Case Number
9	..250	-	XPN	O	*	-	00480	IN2-9	Military Sponsor Name
10	..20	-	ST	O	1	-	00481	IN2-10	Military ID Number
11	..250	-	CE	O	1	0342	00482	IN2-11	Dependent Of Military Recipient
12	..25	-	ST	O	1	-	00483	IN2-12	Military Organization
13	..25	-	ST	O	1	-	00484	IN2-13	Military Station
14	..14	-	IS	O	1	0140	00485	IN2-14	Military Service
15	..2	-	IS	O	1	0141	00486	IN2-15	Military Rank/Grade
16	..3	-	IS	O	1	0142	00487	IN2-16	Military Status
17	..8	-	DT	O	1	-	00488	IN2-17	Military Retire Date
18	..1	-	ID	O	1	0136	00489	IN2-18	Military Non-Avail Cert On File
19	..1	-	ID	O	1	0136	00490	IN2-19	Baby Coverage
20	..1	-	ID	O	1	0136	00491	IN2-20	Combine Baby Bill
21	..1	-	ST	O	1	-	00492	IN2-21	Blood Deductible
22	..250	-	XPN	O	*	-	00493	IN2-22	Special Coverage Approval Name
23	..30	-	ST	O	1	-	00494	IN2-23	Special Coverage Approval Title
24	..8	-	IS	O	*	0143	00495	IN2-24	Non-Covered Insurance Code
25	..250	-	CX	O	*	-	00496	IN2-25	Payor ID
26	..250	-	CX	O	*	-	00497	IN2-26	Payor Subscriber ID
27	..1	-	IS	O	1	0144	00498	IN2-27	Eligibility Source
28	..82	-	RMC	O	*	-	00499	IN2-28	Room Coverage Type/Amount
29	..56	-	PTA	O	*	-	00500	IN2-29	Policy Type/Amount
30	..25	-	DDI	O	1	-	00501	IN2-30	Daily Deductible
31	..2	-	IS	O	1	0223	00755	IN2-31	Living Dependency
32	..2	-	IS	O	*	0009	00145	IN2-32	Ambulatory Status
33	..250	-	CE	O	*	0171	00129	IN2-33	Citizenship
34	..250	-	CE	O	1	0296	00118	IN2-34	Primary Language
35	..2	-	IS	O	1	0220	00742	IN2-35	Living Arrangement
36	..250	-	CE	O	1	0215	00743	IN2-36	Publicity Code
37	..1	-	ID	O	1	0136	00744	IN2-37	Protection Indicator
38	..2	-	IS	O	1	0231	00745	IN2-38	Student Indicator
39	..250	-	CE	O	1	0006	00120	IN2-39	Religion
40	..250	-	XPN	O	*	-	00109	IN2-40	Mother's Maiden Name
41	..250	-	CE	O	1	0212	00739	IN2-41	Nationality
42	..250	-	CE	O	*	0189	00125	IN2-42	Ethnic Group
43	..250	-	CE	O	*	0002	00119	IN2-43	Marital Status
44	..8	-	DT	O	1	-	00787	IN2-44	Insured's Employment Start Date
45	..8	-	DT	O	1	-	00783	IN2-45	Employment Stop Date
46	..20	-	ST	O	1	-	00785	IN2-46	Job Title
47	..20	-	JCC	O	1	-	00786	IN2-47	Job Code/Class
48	..2	-	IS	O	1	0311	00752	IN2-48	Job Status
49	..250	-	XPN	O	*	-	00789	IN2-49	Employer Contact Person Name
50	..250	-	XTN	O	*	-	00790	IN2-50	Employer Contact Person Phone Number
51	..2	-	IS	O	1	0222	00791	IN2-51	Employer Contact Reason
52	..250	-	XPN	O	*	-	00792	IN2-52	Insured's Contact Person's Name
53	..250	-	XTN	O	*	-	00793	IN2-53	Insured's Contact Person Phone Number
54	..2	-	IS	O	*	0222	00794	IN2-54	Insured's Contact Person Reason
55	..8	-	DT	O	1	-	00795	IN2-55	Relationship to the Patient Start Date
56	..8	-	DT	O	*	-	00796	IN2-56	Relationship to the Patient Stop Date
57	..2	-	IS	O	1	0232	00797	IN2-57	Insurance Co. Contact Reason
58	..250	-	XTN	O	1	-	00798	IN2-58	Insurance Co Contact Phone Number
59	..2	-	IS	O	1	0312	00799	IN2-59	Policy Scope
60	..2	-	IS	O	1	0313	00800	IN2-60	Policy Source
61	..250	-	CX	O	1	-	00801	IN2-61	Patient Member Number
62	..250	-	CE	O	1	0063	00802	IN2-62	Guarantor's Relationship to Insured	Name
63	..250	-	XTN	O	*	-	00803	IN2-63	Insured's Phone Number - Home
64	..250	-	XTN	O	*	-	00804	IN2-64	Insured's Employer Phone Number
65	..250	-	CE	O	1	0343	00805	IN2-65	Military Handicapped Program
66	..1	-	ID	O	1	0136	00806	IN2-66	Suspend Flag
67	..1	-	ID	O	1	0136	00807	IN2-67	Copay Limit Flag
68	..1	-	ID	O	1	0136	00808	IN2-68	Stoploss Limit Flag
69	..250	-	XON	O	*	-	00809	IN2-69	Insured Organization Name and ID
70	..250	-	XON	O	*	-	00810	IN2-70	Insured Employer Organization Name and ID
71	..250	-	CE	O	*	0005	00113	IN2-71	Race
72	..250	-	CE	O	1	0344	00811	IN2-72	CMS Patient's Relationship to Insured