IN2

Insurance Additional Information

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2.6Sep2007

2.7Jan2011

2.7.1Jul2012

...

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		v2.6
1	-	-	CX	O	*	-	00472	IN2-1	Insured's Employee ID	Length
2	-	11=	ST	O	1	-	00473	IN2-2	Insured's Social Security Number	2
3	-	-	XCN	O	*	-	00474	IN2-3	Insured's Employer's Name and ID	Length
4	-	-	CWE	O	1	0139	00475	IN2-4	Employer Information Data	2
5	-	-	CWE	O	*	0137	00476	IN2-5	Mail Claim Party	2
6	-	15=	ST	O	1	-	00477	IN2-6	Medicare Health Ins Card Number	2
7	-	-	XPN	O	*	-	00478	IN2-7	Medicaid Case Name	Length
8	-	15=	ST	O	1	-	00479	IN2-8	Medicaid Case Number	2
9	-	-	XPN	O	*	-	00480	IN2-9	Military Sponsor Name	Length
10	-	20=	ST	O	1	-	00481	IN2-10	Military ID Number	2
11	-	-	CWE	O	1	0342	00482	IN2-11	Dependent Of Military Recipient	Length
12	-	25=	ST	O	1	-	00483	IN2-12	Military Organization	2
13	-	25=	ST	O	1	-	00484	IN2-13	Military Station	2
14	-	-	CWE	O	1	0140	00485	IN2-14	Military Service	2
15	-	-	CWE	O	1	0141	00486	IN2-15	Military Rank/Grade	2
16	-	-	CWE	O	1	0142	00487	IN2-16	Military Status	2
17	-	-	DT	O	1	-	00488	IN2-17	Military Retire Date	Length
18	1	-	ID	O	1	0136	00489	IN2-18	Military Non-Avail Cert On File	Min Length
19	1	-	ID	O	1	0136	00490	IN2-19	Baby Coverage	Min Length
20	1	-	ID	O	1	0136	00491	IN2-20	Combine Baby Bill	Min Length
21	-	1=	ST	O	1	-	00492	IN2-21	Blood Deductible	2
22	-	-	XPN	O	*	-	00493	IN2-22	Special Coverage Approval Name	Length
23	-	30#	ST	O	1	-	00494	IN2-23	Special Coverage Approval Title	2
24	-	-	CWE	O	*	0143	00495	IN2-24	Non-Covered Insurance Code	2
25	-	-	CX	O	*	-	00496	IN2-25	Payor ID	Length
26	-	-	CX	O	*	-	00497	IN2-26	Payor Subscriber ID	Length
27	-	-	CWE	O	1	0144	00498	IN2-27	Eligibility Source	2
28	-	-	RMC	O	*	-	00499	IN2-28	Room Coverage Type/Amount	Length
29	-	-	PTA	O	*	-	00500	IN2-29	Policy Type/Amount	Length
30	-	-	DDI	O	1	-	00501	IN2-30	Daily Deductible	Length
31	-	-	CWE	O	1	0223	00755	IN2-31	Living Dependency	2
32	-	-	CWE	O	*	0009	00145	IN2-32	Ambulatory Status	2
33	-	-	CWE	O	*	0171	00129	IN2-33	Citizenship	Length
34	-	-	CWE	O	1	0296	00118	IN2-34	Primary Language	Length
35	-	-	CWE	O	1	0220	00742	IN2-35	Living Arrangement	2
36	-	-	CWE	O	1	0215	00743	IN2-36	Publicity Code	Length
37	1	-	ID	O	1	0136	00744	IN2-37	Protection Indicator	2
38	-	-	CWE	O	1	0231	00745	IN2-38	Student Indicator	2
39	-	-	CWE	O	1	0006	00120	IN2-39	Religion	Length
40	-	-	XPN	O	*	-	00109	IN2-40	Mother's Maiden Name	Length
41	-	-	CWE	O	1	0212	00739	IN2-41	Nationality
42	-	-	CWE	O	*	0189	00125	IN2-42	Ethnic Group	Length
43	-	-	CWE	O	*	0002	00119	IN2-43	Marital Status	Length
44	-	-	DT	O	1	-	00787	IN2-44	Insured's Employment Start Date	Length
45	-	-	DT	O	1	-	00783	IN2-45	Employment Stop Date	Length
46	-	20#	ST	O	1	-	00785	IN2-46	Job Title	2
47	-	-	JCC	O	1	0327	00786	IN2-47	Job Code/Class	2
48	-	-	CWE	O	1	0311	00752	IN2-48	Job Status	2
49	-	-	XPN	O	*	-	00789	IN2-49	Employer Contact Person Name	Length
50	-	-	XTN	O	*	-	00790	IN2-50	Employer Contact Person Phone Number	Length
51	-	-	CWE	O	1	0222	00791	IN2-51	Employer Contact Reason	2
52	-	-	XPN	O	*	-	00792	IN2-52	Insured's Contact Person's Name	Length
53	-	-	XTN	O	*	-	00793	IN2-53	Insured's Contact Person Phone Number	Length
54	-	-	CWE	O	*	0222	00794	IN2-54	Insured's Contact Person Reason	2
55	-	-	DT	O	1	-	00795	IN2-55	Relationship to the Patient Start Date	Length
56	-	-	DT	O	*	-	00796	IN2-56	Relationship to the Patient Stop Date	Length
57	-	-	CWE	O	1	0232	00797	IN2-57	Insurance Co Contact Reason	2
58	-	-	XTN	O	*	-	00798	IN2-58	Insurance Co Contact Phone Number	Length
59	-	-	CWE	O	1	0312	00799	IN2-59	Policy Scope	2
60	-	-	CWE	O	1	0313	00800	IN2-60	Policy Source	2
61	-	-	CX	O	1	-	00801	IN2-61	Patient Member Number	Length
62	-	-	CWE	O	1	0063	00802	IN2-62	Guarantor's Relationship to Insured	Length
63	-	-	XTN	O	*	-	00803	IN2-63	Insured's Phone Number - Home	Length
64	-	-	XTN	O	*	-	00804	IN2-64	Insured's Employer Phone Number	Length
65	-	-	CWE	O	1	0343	00805	IN2-65	Military Handicapped Program	Length
66	1	-	ID	O	1	0136	00806	IN2-66	Suspend Flag	Min Length
67	1	-	ID	O	1	0136	00807	IN2-67	Copay Limit Flag	Min Length
68	1	-	ID	O	1	0136	00808	IN2-68	Stoploss Limit Flag	Min Length
69	-	-	XON	O	*	-	00809	IN2-69	Insured Organization Name and ID	Length
70	-	-	XON	O	*	-	00810	IN2-70	Insured Employer Organization Name and ID	Length
71	-	-	CWE	O	*	0005	00113	IN2-71	Race	Length
72	-	-	CWE	O	1	0344	00811	IN2-72	Patient's Relationship to Insured	Length