IN1

Insurance

FHIR:Coverage
The IN1 segment contains insurance policy coverage information necessary to produce properly pro-rated and patient and insurance bills.
55
C.LenElementv2.7FHIR
11..4-SIR1-00426IN1-1Set ID - IN1-
2--CWER1007200368IN1-2Health Plan IDidentifier
3--CXR*-00428IN1-3Insurance Company ID-
4--XONO*-00429IN1-4Insurance Company Namepayor[1](Organization)
5--XADO*-00430IN1-5Insurance Company Addresspayer[1](Organization.address)
6--XPNO*-00431IN1-6Insurance Co Contact Person-
7--XTNO*-00432IN1-7Insurance Co Phone Number-
8-12=STO1-00433IN1-8Group Number-
9--XONO*-00434IN1-9Group Name-
10--CXO*-00435IN1-10Insured's Group Emp ID3 mappings
11--XONO*-00436IN1-11Insured's Group Emp NamepolicyHolder[1](Organization)
12--DTO1-00437IN1-12Plan Effective Dateperiod.start
13--DTO1-00438IN1-13Plan Expiration Dateperiod.end
14--AUIO1-00439IN1-14Authorization Information-
15--CWEO1008600440IN1-15Plan Typetype
16--XPNO*-00441IN1-16Name Of Insured2 mappings
17--CWEO1006300442IN1-17Insured's Relationship To Patientrelationship
18--DTMO1-00443IN1-18Insured's Date Of Birth-
19--XADO*-00444IN1-19Insured's Address-
20--CWEO1013500445IN1-20Assignment Of Benefits-
21--CWEO1017300446IN1-21Coordination Of Benefits-
22-2=STO1-00447IN1-22Coord Of Ben. Priority-
231-IDO1013600448IN1-23Notice Of Admission Flag-
24--DTO1-00449IN1-24Notice Of Admission Date-
251-IDO1013600450IN1-25Report Of Eligibility Flag-
26--DTO1-00451IN1-26Report Of Eligibility Date-
27--CWEO1009300452IN1-27Release Information Code-
28-15=STO1-00453IN1-28Pre-Admit Cert (PAC)-
29--DTMO1-00454IN1-29Verification Date/Time-
30--XCNO*-00455IN1-30Verification By-
31--CWEO1009800456IN1-31Type Of Agreement Code-
32--CWEO1002200457IN1-32Billing Status-
33-4=NMO1-00458IN1-33Lifetime Reserve Days-
34-4=NMO1-00459IN1-34Delay Before L.R. Day-
35--CWEO1004200460IN1-35Company Plan Code-
36-15=STO1-00461IN1-36Policy Number-
37--CPO1-00462IN1-37Policy Deductible-
38---W1-00463IN1-38Policy Limit - Amount-
39-4=NMO1-00464IN1-39Policy Limit - Days-
40---W1-00465IN1-40Room Rate - Semi-Private-
41---W1-00466IN1-41Room Rate - Private-
42--CWEO1006600467IN1-42Insured's Employment Status-
43--CWEO1000100468IN1-43Insured's Administrative Sex-
44--XADO*-00469IN1-44Insured's Employer's Address-
45-2=STO1-00470IN1-45Verification Status-
46--CWEO1007200471IN1-46Prior Insurance Plan ID-
47--CWEO1030901227IN1-47Coverage Type-
48--CWEO1029500753IN1-48Handicap-
49--CXO*-01230IN1-49Insured's ID Number2 mappings
50--CWEO1053501854IN1-50Signature Code-
51--DTO1-01855IN1-51Signature Code Date-
52--STO1-01899IN1-52Insured's Birth Place-
53--CWEO1009901852IN1-53VIP Indicator-
54--CXO*-03292IN1-54External Health Plan Identifiers-
55..1-IDO1020603335IN1-55Insurance Action CodeNEW-
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