The IN1 segment contains insurance policy coverage information necessary to produce properly pro-rated and patient and insurance bills.
Figure 6-6. IN1 attributes
SEQ |
LEN |
DT |
OPT |
RP/# |
TBL# |
ITEM# |
ELEMENT NAME |
1 |
4 |
SI |
R |
00426 |
Set ID - IN1 |
||
2 |
60 |
CE |
R |
0072 |
00368 |
Insurance Plan ID |
|
3 |
59 |
CX |
R |
Y |
00428 |
Insurance Company ID |
|
4 |
130 |
XON |
O |
Y |
00429 |
Insurance Company Name |
|
5 |
106 |
XAD |
O |
Y |
00430 |
Insurance Company Address |
|
6 |
48 |
XPN |
O |
Y |
00431 |
Insurance Co. Contact Person |
|
7 |
40 |
XTN |
O |
Y |
00432 |
Insurance Co Phone Number |
|
8 |
12 |
ST |
O |
00433 |
Group Number |
||
9 |
130 |
XON |
O |
Y |
00434 |
Group Name |
|
10 |
12 |
CX |
O |
Y |
00435 |
Insureds Group Emp ID |
|
11 |
130 |
XON |
O |
Y |
00436 |
Insureds Group Emp Name |
|
12 |
8 |
DT |
O |
00437 |
Plan Effective Date |
||
13 |
8 |
DT |
O |
00438 |
Plan Expiration Date |
||
14 |
55 |
CM |
O |
00439 |
Authorization Information |
||
15 |
3 |
IS |
O |
0086 |
00440 |
Plan Type |
|
16 |
48 |
XPN |
O |
Y |
00441 |
Name Of Insured |
|
17 |
2 |
IS |
O |
0063 |
00442 |
Insureds Relationship To Patient |
|
18 |
26 |
TS |
O |
00443 |
Insureds Date Of Birth |
||
19 |
106 |
XAD |
O |
Y |
00444 |
Insureds Address |
|
20 |
2 |
IS |
O |
0135 |
00445 |
Assignment Of Benefits |
|
21 |
2 |
IS |
O |
0173 |
00446 |
Coordination Of Benefits |
|
22 |
2 |
ST |
O |
00447 |
Coord Of Ben. Priority |
||
23 |
2 |
ID |
O |
0136 |
00448 |
Notice Of Admission Flag |
|
24 |
8 |
DT |
O |
00449 |
Notice Of Admission Date |
||
25 |
2 |
ID |
O |
0136 |
00450 |
Report Of Eligibility Flag |
|
26 |
8 |
DT |
O |
00451 |
Report Of Eligibility Date |
||
27 |
2 |
IS |
O |
0093 |
00452 |
Release Information Code |
|
28 |
15 |
ST |
O |
00453 |
Pre-Admit Cert (PAC) |
||
29 |
26 |
TS |
O |
00454 |
Verification Date/Time |
||
30 |
60 |
XCN |
O |
00455 |
Verification By |
||
31 |
2 |
IS |
O |
0098 |
00456 |
Type Of Agreement Code |
|
32 |
2 |
IS |
O |
0022 |
00457 |
Billing Status |
|
33 |
4 |
NM |
O |
00458 |
Lifetime Reserve Days |
||
34 |
4 |
NM |
O |
00459 |
Delay Before L.R. Day |
||
35 |
8 |
IS |
O |
0042 |
00460 |
Company Plan Code |
|
36 |
15 |
ST |
O |
00461 |
Policy Number |
||
37 |
12 |
CP |
O |
00462 |
Policy Deductible |
||
38 |
12 |
CP |
B |
00463 |
Policy Limit - Amount |
||
39 |
4 |
NM |
O |
00464 |
Policy Limit - Days |
||
40 |
12 |
CP |
B |
00465 |
Room Rate - Semi-Private |
||
41 |
12 |
CP |
B |
00466 |
Room Rate - Private |
||
42 |
60 |
CE |
O |
0066 |
00467 |
Insureds Employment Status |
|
43 |
1 |
IS |
O |
0001 |
00468 |
Insureds Sex |
|
44 |
106 |
XAD |
O |
Y |
00469 |
Insureds Employer Address |
|
45 |
2 |
ST |
O |
00470 |
Verification Status |
||
46 |
8 |
IS |
O |
0072 |
00471 |
Prior Insurance Plan ID |
|
47 |
3 |
IS |
O |
0309 |
01227 |
Coverage Type |
|
48 |
2 |
IS |
O |
0310 |
00753 |
Handicap |
|
49 |
12 |
CX |
O |
Y |
01230 |
Insureds ID Number |
6.4.6.0 IN1 field definitions
Definition: IN1-1-set ID contains the number that identifies this transaction . For the first occurrence the sequence number shall be 1, for the second occurrence it shall be 2, etc.
Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (ST)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (ST)>
Definition: This field contains a unique identifier for the insurance plan. Refer to user-defined table 0072 - Insurance plan ID. To eliminate a plan, the plan could be sent with null values in each subsequent element. If the respective systems can support it, a null value can be sent in the plan field.
Components: <ID (ST)> ^ <check digit (ST)> ^ <code identifying the check digit scheme employed (ID)> ^ <assigning authority (HD)> ^ <identifier type code (IS)> ^ <assigning facility (HD)>
Subcomponents of assigning authority: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Definition: This field contains a unique identifier the insurance company.
Components: <organization name (ST)> ^ <organization name type code (ID)> ^ <ID number (ID)> ^ <check digit (NM)> ^ < check digit scheme (ID)> ^ <assigning authority (HD)> ^ <identifier type code (ID)> ^ <assigning facility ID (HD)>
Subcomponents of assigning authority: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Definition: This field contains the name of the insurance company. Multiple names for the same insurance company may be sent in this field. The legal name is assumed to be in the first repetition. When the legal name is not sent, a repeat delimiter must be sent first for the first repetition. The components of this data type are described in Chapter 2.
Components: <street address (ST)> ^ <other designation (ST)> ^ <city (ST)> ^ <state or province (ST)> ^ <zip or postal code(ST)> ^ <country (ID)> ^ < address type (ID)> ^ <other geographic designation (ST)>^ <county/parish code (IS)> ^ <census tract (IS)>
Definition: This field contains the address of the insurance company. Multiple addresses for the same insurance company may be sent in this field. The mailing address is assumed to be in the first repetition. When the mailing address is not sent, a repeat delimiter must be sent first for the first repetition.
Components: <family name (ST)> ^ <given name (ST)> ^ <middle initial or name (ST)> ^ <suffix (e.g., JR or III) (ST)> ^ <prefix (e.g., DR) (ST)> ^ <degree (e.g., MD) (ST)> ^ <name type code (ID) >
Definition: This field contains the name of the person who should be contacted at the insurance company. Multiple names for the same contact person may be sent in this field. The legal name is assumed to be in the first repetition. When the legal name is not sent, a repeat delimiter must be sent first for the first repetition. The components of this data type are described in Chapter 2.
Components: [NNN] [(999)]999-9999 [X99999] [B99999] [C any text] ^<telecommunication use code (ID)> ^ <telecommunication equipment type (ID)> ^ <email address (ST)> ^ <country code (NM)> ^ <area/city code (NM)> ^ <phone number (NM)> ^ <extension (NM)> ^ <any text (ST)>
Definition: This field contains the phone number of the insurance company. Multiple phone numbers for the same insurance company may be sent in this field. The primary phone number is assumed to be in the first repetition. When the primary phone number is not sent, a repeat delimiter must be sent first for the first repetition. The components of this data type are described in Chapter 2.
Definition: This field contains the group number of the insureds insurance.
Components: <organization name (ST)> ^ <organization name type code (ID)> ^ <ID number (ID)> ^ <check digit (NM)> ^ < check digit scheme (ID)> ^ <assigning authority (HD)> ^ <identifier type code (ID)> ^ <assigning facility ID (HD)>
Subcomponents of assigning authority: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Definition: This field contains the group name of the insureds insurance. The components of this data type are described in Chapter 2.
Components: <ID (ST)> ^ <check digit (ST)> ^ <code identifying the check digit scheme employed (ID)> ^ <assigning authority (HD)> ^ <identifier type code (IS)> ^ <assigning facility (HD)
Subcomponents of assigning authority: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Definition: This field holds the group employer ID for the insureds insurance.
Components: <organization name (ST)> ^ <organization name type code (ID)> ^ <ID number (ID)> ^ <check digit (NM)> ^ < check digit scheme (ID)> ^ <assigning authority (HD)> ^ <identifier type code (ID)> ^ <assigning facility ID (HD)>
Subcomponents of assigning authority: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Definition: This field contains the name of the employer that provides the employees insurance. Multiple names for the same employer may be sent in this sequence. The legal name must be sent first. When the legal name is not sent, a repeat delimiter must be sent first for the first repetition. The components of this data type are described in Chapter 2.
Definition: This field contains the date that the insurance goes into effect.
Definition: This field indicates the last date of service that the insurance will cover or be responsible for.
Components: <authorization number (ST)> ^ <date (DT)> ^ <source (ST)>
Definition: Based on the type of insurance, some coverage plans require that an authorization number or code be obtained prior to all non-emergency admissions, and within 48 hours of an emergency admission. Insurance billing would not be permitted without this number. The date and source of authorization are the components of this field.
Definition: This field contains the coding structure that identifies the various plan types, for example, Medicare, Medicaid, Blue Cross, HMO, etc. Refer to user-defined table 0086 - Plan ID for suggested values.
Components: <family name (ST)> ^ <given name (ST)> ^ <middle initial or name (ST)> ^ <suffix (e.g., JR or III) (ST)> ^ <prefix (e.g., DR) (ST)> ^ <degree (e.g., MD) (ST)>^ <name type code (ID) >
Definition: This field contains the name of the insured person. The insured is the person who has an agreement with the insurance company to provide healthcare services to persons covered by the insurance policy. Multiple names for the same insured person may be sent in this field. The legal name is assumed to be in the first repetition. When the legal name is not sent, a repeat delimiter must be sent first for the first repetition. The components of this data type are described in Chapter 2.
Definition: This field indicates the insureds relationship to the patient. Refer to user-defined table 0063 - Relationship for suggested values.
Definition: This field contains the date of birth of the insured.
Components: <street address (ST)> ^ <other designation (ST)> ^ <city (ST)> ^ <state or province (ST)> ^ <zip or postal code(ST)> ^ <country (ID)> ^ < address type (ID)> ^ <other geographic designation (ST)>^ <county/parish code (IS)> ^ <census tract (IS)>
Definition: This field contains the address of the insured person. The insured is the person who has an agreement with the insurance company to provide healthcare services to persons covered by an insurance policy. Multiple addresses for the same insured person may be in this field. The mailing address must be sent in the first repetition. When the legal name is not sent, a repeat delimiter must be sent first for the first repetition.
Definition: This field indicates whether the insured agreed to assign the insurance benefits to the healthcare provider. If so, the insurance will pay the provider directly. Refer to user-defined table 0135 - Assignment of benefits for suggested values.
User-defined Table 0135 - Assignment of benefits
Value |
Description |
Y N M |
Yes No Modified assignment |
Definition: This field indicates whether this insurance works in conjunction with other insurance plans, or if it provides independent coverage and payment of benefits regardless of other insurance that might be available to the patient. Refer to user-defined table 0173 - Coordination of benefits for suggested values.
User-defined Table 0173 - Coordination of benefits
Value |
Description |
CO |
Coordination |
IN |
Independent |
Definition: If the insurance works in conjunction with other insurance plans, this field contains priority sequence. Values are: 1, 2, 3, etc.
Definition: This field indicates whether the insurance company requires a written notice of admission from the healthcare provider. Refer to HL7 table 0136 - Yes/no indicator for valid values.
Definition: If a notice is required, this field indicates the date that it was sent.
Definition: This field indicates whether this insurance carrier sends a report that indicates that the patient is eligible for benefits and whether it identifies those benefits. Refer to HL7 table 0136 - Yes/no indicator for valid values.
Definition: This field indicates whether a report of eligibility (ROE) was received, and also indicates the date that it was received.
Definition: This field indicates whether the healthcare provider can release information about the patient, and what information can be released. Refer to user-defined table 0093 - Release information code for suggested values.
User-defined Table 0093 - Release information
Value |
Description |
Y |
Yes |
N |
No |
or user-defined codes |
Definition: This field contains the pre-admission certification code. If the admission must be certified before the admission, this is the code associated with the admission.
Definition: This field contains the date/time that the healthcare provider verified that the patient has the indicated benefits.
Components: <ID number (ST)> ^ <family name (ST)> ^ <given name (ST)> ^ <middle initial or name (ST)> ^ <suffix (e.g., JR or III) (ST)> ^ <prefix (e.g., DR) (ST)> ^ <degree (e.g., MD) (ST)> ^ <source table (IS)> ^ <assigning authority (HD)> ^ <name type code(ID)> ^ <identifier check digit (ST)> ^ <code identifying the check digit scheme employed (ID)> ^ <identifier type code (IS)> ^ <assigning facility (HD)>
Subcomponents of assigning authority: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Definition: Refers to the person who verified the benefits. Multiple names for the same insured person may be sent in this field. The legal name is assumed to be in the first repetition. When the legal name is not sent, a repeat delimiter must be sent first for the first repetition. The components of this data type are described in Chapter 2.
Definition: This field is used to further identify an insurance plan. Refer to user-defined table 0098 - Type of agreement for suggested values. Refer to user-defined table 0098 - Type of agreement for suggested values.
User-defined Table 0098 - Type of agreement
Value |
Description |
S |
Standard |
U |
Unified |
M |
Maternity |
Definition: This field indicates whether the particular insurance has been billed and, if so, the type of bill. Refer to user-defined table 0022 - Billing status for suggested values.
Definition: This field contains the number of days left for a certain service to be provided or covered under an insurance policy.
Definition: This field indicates the delay before lifetime reserve days.
Definition: This field contains optional information to further define the data in IN1-3-insurance company ID. Refer to user-defined table 0042 - Company plan code. This table contains codes used to identify an insurance plan uniquely.
Definition: This field contains the individual policy number of the insured to uniquely identify this patients plan. For special types of insurance numbers, there are also special fields in the IN2 segment for Medicaid, Medicare, Champus (i.e., IN2-8-Medicaid case number, IN2-6-Medicare health ins card number, IN2-10-Champus ID number). But we recommend that this field (IN1-36-policy number) be filled even when the patients insurance number is also passed in one of these other fields.
Components: <price (MO)> ^ <price type (ID)> ^ <from value (NM)> ^ <to value (NM)> ^ <range units (CE)> ^ <range type (ID)>
Definition: This field contains the amount specified by the insurance plan that is the responsibility of the guarantor.
Components: <price (MO)> ^ <price type (ID)> ^ <from value (NM)> ^ <to value (NM)> ^ <range units (CE)> ^ <range type (ID)>
Definition: This field has been retained for backward compatibility only. Use IN2-policy type/amount instead of this field. This field contains the maximum amount that the insurance policy will pay. In some cases, the limit may be for a single encounter.
Definition: This field contains the maximum number of days that the insurance policy will cover.
Components: <price (MO)> ^ <price type (ID)> ^ <from value (NM)> ^ <to value (NM)> ^ <range units (CE)> ^ <range type (ID)>
Definition: This field has been retained for backward compatibility only. Use IN2-28-room coverage type/amount instead of this field. When used for backward compatibility, IN2-40-room rate--semi-primate contains the average room rate that the policy covers.
Components: <price (MO)> ^ <price type (ID)> ^ <from value (NM)> ^ <to value (NM)> ^ <range units (CE)> ^ <range type (ID)>
Definition: This field has been retained for backward compatibility only. Use IN2-28-room coverage type/amount instead of this field. When used for backward compatibility IN2-29-room rate--private contains the maximum private room rate that the policy covers.
Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (ST)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (ST)>
Definition: Refer to user-defined table 0066 - Employment status for suggested values.
Definition: This field contains the gender of the insured. Refer to user-defined table 0001 - Sex for valid values.
Components: <street address (ST)> ^ <other designation (ST)> ^ <city (ST)> ^ <state or province (ST)> ^ <zip or postal code(ST)> ^ <country (ID)> ^ < address type (ID)> ^ <other geographic designation (ST)> ^ <county/parish code (IS)> ^ <census tract (IS)>
Definition: This field contains the address of the insured employees employer. Multiple addresses for the same employer may be sent in this field. The mailing address must be sent first. When the mailing address is not sent, a repeat delimiter must be sent first for the first repetition.
Definition: This field contains the status of this patients relationship with this insurance carrier.
Definition: This field uniquely identifies the prior insurance plan when the plan ID changes. Refer to user-defined table 0072 - Insurance plan ID for suggested values.
Definition: This field contains the coding structure that identifies the type of insurance coverage, or what type of services are covered for the purposes of a billing system. For example, a physician billing system will only want to receive insurance information for plans which cover physician/professional charges. Refer to user-defined table 0309 - Coverage type for suggested values.
User-defined Table 0309 - Coverage type
Value |
Description |
H |
Hospital/Institutional |
P |
Physician/Professional |
B |
Both Hospital and Physician |
Definition: This field contains a code to describe the insureds disability. Refer to user-defined table 0310 - Handicap for suggested values.
Components: <ID (ST)> ^ <check digit (ST)> ^ <code identifying the check digit scheme employed (ID)> ^ <assigning authority (HD)> ^ <identifier type code (IS)> ^ <assigning facility (HD)
Subcomponents of assigning authority: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Subcomponents of assigning facility: <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID)
Definition: This data element contains a healthcare institutions identifiers for the insured.