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 CMS, or other regulatory agencies.
RRequiredOOptionalCConditionalWWithdrawn|#Date/Time*Backward compat.+Filler
25
| C.Len | Element | v2.6 | FHIR | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 1..4 | - | SI | R | 1 | - | 00502 | IN3-1 | Set ID - IN3 | Min Length | - |
| 2 | - | - | CX | O | 1 | - | 00503 | IN3-2 | Certification Number | Length | - |
| 3 | - | - | XCN | O | * | - | 00504 | IN3-3 | Certified By | Length | - |
| 4 | 1 | - | ID | O | 1 | 0136 | 00505 | IN3-4 | Certification Required | Min Length | - |
| 5 | - | - | MOP | O | 1 | - | 00506 | IN3-5 | Penalty | Length | - |
| 6 | - | - | DTM | O | 1 | - | 00507 | IN3-6 | Certification Date/Time | Length | - |
| 7 | - | - | DTM | O | 1 | - | 00508 | IN3-7 | Certification Modify Date/Time | Length | - |
| 8 | - | - | XCN | O | * | - | 00509 | IN3-8 | Operator | Length | - |
| 9 | - | - | DT | O | 1 | - | 00510 | IN3-9 | Certification Begin Date | Length | - |
| 10 | - | - | DT | O | 1 | - | 00511 | IN3-10 | Certification End Date | Length | - |
| 11 | - | - | DTN | O | 1 | - | 00512 | IN3-11 | Days | Length | - |
| 12 | - | - | CWE | O | 1 | 0233 | 00513 | IN3-12 | Non-Concur Code/Description | Length | - |
| 13 | - | - | DTM | O | 1 | - | 00514 | IN3-13 | Non-Concur Effective Date/Time | Length | - |
| 14 | - | - | XCN | O | * | 0010 | 00515 | IN3-14 | Physician Reviewer | Length | - |
| 15 | - | 48# | ST | O | 1 | - | 00516 | IN3-15 | Certification Contact | 2 | - |
| 16 | - | - | XTN | O | * | - | 00517 | IN3-16 | Certification Contact Phone Number | Length | - |
| 17 | - | - | CWE | O | 1 | 0345 | 00518 | IN3-17 | Appeal Reason | Length | - |
| 18 | - | - | CWE | O | 1 | 0346 | 00519 | IN3-18 | Certification Agency | Length | - |
| 19 | - | - | XTN | O | * | - | 00520 | IN3-19 | Certification Agency Phone Number | Length | - |
| 20 | - | - | ICD | O | * | - | 00521 | IN3-20 | Pre-Certification Requirement | Length | - |
| 21 | - | 48# | ST | O | 1 | - | 00522 | IN3-21 | Case Manager | 2 | 3 mappings |
| 22 | - | - | DT | O | 1 | - | 00523 | IN3-22 | Second Opinion Date | Length | - |
| 23 | - | - | CWE | O | 1 | 0151 | 00524 | IN3-23 | Second Opinion Status | 2 | - |
| 24 | - | - | CWE | O | * | 0152 | 00525 | IN3-24 | Second Opinion Documentation Received | 2 | - |
| 25 | - | - | XCN | O | * | 0010 | 00526 | IN3-25 | Second Opinion Physician | Length | - |
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