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 HCFA or other regulatory agencies.
Figure 6-7. IN2 attributes
SEQ |
LEN |
DT |
OPT |
RP/# |
TBL# |
ITEM# |
ELEMENT NAME |
1 |
59 |
CX |
O |
Y |
00472 |
Insureds Employee ID |
|
2 |
11 |
ST |
O |
00473 |
Insureds Social Security Number |
||
3 |
130 |
XCN |
O |
Y |
00474 |
Insureds Employer Name |
|
4 |
1 |
IS |
O |
0139 |
00475 |
Employer Information Data |
|
5 |
1 |
IS |
O |
Y |
0137 |
00476 |
Mail Claim Party |
6 |
15 |
ST |
O |
00477 |
Medicare Health Ins Card Number |
||
7 |
48 |
XPN |
O |
Y |
00478 |
Medicaid Case Name |
|
8 |
15 |
ST |
O |
00479 |
Medicaid Case Number |
||
9 |
48 |
XPN |
O |
Y |
00480 |
Champus Sponsor Name |
|
10 |
20 |
ST |
O |
00481 |
Champus ID Number |
||
11 |
80 |
CE |
O |
00482 |
Dependent Of Champus Recipient |
||
12 |
25 |
ST |
O |
00483 |
Champus Organization |
||
13 |
25 |
ST |
O |
00484 |
Champus Station |
||
14 |
14 |
IS |
O |
0140 |
00485 |
Champus Service |
|
15 |
2 |
IS |
O |
0141 |
00486 |
Champus Rank/Grade |
|
16 |
3 |
IS |
O |
0142 |
00487 |
Champus Status |
|
17 |
8 |
DT |
O |
00488 |
Champus Retire Date |
||
18 |
1 |
ID |
O |
0136 |
00489 |
Champus Non-Avail Cert On File |
|
19 |
1 |
ID |
O |
0136 |
00490 |
Baby Coverage |
|
20 |
1 |
ID |
O |
0136 |
00491 |
Combine Baby Bill |
|
21 |
1 |
ST |
O |
00492 |
Blood Deductible |
||
22 |
48 |
XPN |
O |
Y |
00493 |
Special Coverage Approval Name |
|
23 |
30 |
ST |
O |
00494 |
Special Coverage Approval Title |
||
24 |
8 |
IS |
O |
Y |
0143 |
00495 |
Non-Covered Insurance Code |
25 |
59 |
CX |
O |
Y |
00496 |
Payor ID |
|
26 |
59 |
CX |
O |
Y |
00497 |
Payor Subscriber ID |
|
27 |
1 |
IS |
O |
0144 |
00498 |
Eligibility Source |
|
28 |
25 |
CM |
O |
Y |
0145/ 0146 |
00499 |
Room Coverage Type/Amount |
29 |
25 |
CM |
O |
Y |
0147/ 0193 |
00500 |
Policy Type/Amount |
30 |
25 |
CM |
O |
00501 |
Daily Deductible |
||
31 |
2 |
IS |
O |
0223 |
00755 |
Living Dependency |
|
32 |
2 |
IS |
O |
0009 |
00145 |
Ambulatory Status |
|
33 |
4 |
IS |
O |
0171 |
00129 |
Citizenship |
|
34 |
60 |
CE |
O |
0296 |
00118 |
Primary Language |
|
35 |
2 |
IS |
O |
0220 |
00742 |
Living Arrangement |
|
36 |
80 |
IS |
O |
0215 |
00743 |
Publicity Indicator |
|
37 |
1 |
ID |
O |
0136 |
00744 |
Protection Indicator |
|
38 |
2 |
IS |
O |
0231 |
00745 |
Student Indicator |
|
39 |
3 |
IS |
O |
0006 |
00120 |
Religion |
|
40 |
48 |
XPN |
O |
00746 |
Mothers Maiden Name |
||
41 |
80 |
CE |
O |
0212 |
00739 |
Nationality |
|
42 |
3 |
IS |
O |
0189 |
00125 |
Ethnic Group |
|
43 |
1 |
IS |
O |
Y |
0002 |
00119 |
Marital Status |
44 |
8 |
DT |
O |
00787 |
Insureds Employment Start Date |
||
45 |
8 |
DT |
O |
00783 |
Insureds Employment Stop Date |
||
46 |
20 |
ST |
O |
00785 |
Job Title |
||
47 |
20 |
JCC |
O |
0327/
|
00786 |
Job Code/Class |
|
48 |
2 |
IS |
O |
0311 |
00752 |
Job Status |
|
49 |
48 |
XPN |
O |
Y |
00789 |
Employer Contact Person Name |
|
50 |
40 |
XTN |
O |
Y |
00790 |
Employer Contact Person Phone Number |
|
51 |
2 |
IS |
O |
0222 |
00791 |
Employer Contact Reason |
|
52 |
48 |
XPN |
O |
Y |
00792 |
Insureds Contact Persons Name |
|
53 |
40 |
XTN |
O |
Y |
00793 |
Insureds Contact Person Telephone Number |
|
54 |
2 |
IS |
O |
Y |
0222 |
00794 |
Insureds Contact Person Reason |
55 |
8 |
DT |
O |
00795 |
Relationship To The Patient Start Date |
||
56 |
8 |
DT |
O |
Y |
00796 |
Relationship To The Patient Stop Date |
|
57 |
2 |
IS |
O |
0232 |
00797 |
Insurance Co. Contact Reason |
|
58 |
40 |
XTN |
O |
00798 |
Insurance Co Contact Phone Number |
||
59 |
2 |
IS |
O |
0312 |
00799 |
Policy Scope |
|
60 |
2 |
IS |
O |
0313 |
00800 |
Policy Source |
|
61 |
60 |
CX |
O |
00801 |
Patient Member Number |
||
62 |
2 |
IS |
O |
0063 |
00802 |
Guarantors Relationship To Insured |
|
63 |
40 |
XTN |
O |
Y |
00803 |
Insureds Telephone Number - Home |
|
64 |
40 |
XTN |
O |
Y |
00804 |
Insureds Employer Telephone Number |
|
65 |
60 |
CE |
O |
00805 |
Military Handicapped Program |
||
66 |
2 |
ID |
O |
0136 |
00806 |
Suspend Flag |
|
67 |
2 |
ID |
O |
0136 |
00807 |
Copay Limit Flag |
|
68 |
2 |
ID |
O |
0136 |
00808 |
Stoploss Limit Flag |
|
69 |
130 |
XON |
O |
Y |
00809 |
Insured Organization Name And ID |
|
70 |
130 |
XON |
O |
Y |
00810 |
Insured Employer Organization Name And ID |
|
71 |
1 |
IS |
O |
0005 |
00113 |
Race |
|
72 |
60 |
CE |
O |
00811 |
HCFA Patient Relationship to Insured |
6.4.7.0 IN2 field definitions
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 fields contains the employee ID of the insured.
Definition: This fields contains the social security number of the insured.
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: This field contains the name of insureds employer or the person who purchased the insurance for the insured. Multiple names for the same employer 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. When the employer is an organization use IN2-70-insured employer organization name and ID. The components for this data type are described in Chapter 2.
Definition: This field contains the required employer information data for UB82 form locator 71. Refer to user-defined table 0139 - Employer information data for suggested values.
Definition: This field contains the party to which the claim should be mailed. Refer to user-defined table 0137 - Mail claim party for suggested values.
User-defined Table 0137 - Mail claim party
Value |
Description |
E G I O P |
Employer Guarantor Insurance company Other Patient |
Definition: This field contains the Medicare Health Insurance Number (HIN), defined by HCFA or other regulatory agencies.
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 Medicaid case name, defined by HCFA or other regulatory agencies. Multiple names for the same 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 for this data type are described in Chapter 2.
Definition: This field contains the Medicaid case number, defined by HCFA or other regulatory agencies, which uniquely identifies a patients Medicaid policy.
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 is defined by HCFA or other regulatory agencies. Multiple names for the same 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.
Definition: This field contains the Champus ID number, defined by HCFA or other regulatory agencies, which uniquely identifies a patients Champus policy.
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 is defined by HCFA or other regulatory agencies.
Definition: This field is defined by HCFA or other regulatory agencies.
Definition: This field is defined by HCFA or other regulatory agencies.
Definition: This field is defined by HCFA or other regulatory agencies. Refer to user-defined table 0140 - Champus service for suggested values.
Definition: This user-defined field identifies the Champus military rank/grade of the insured. Refer to user-defined table 0141 - Champus rank/grade for suggested values.
Definition: This field is defined by HCFA or other regulatory agencies. Refer to user-defined table 0142 - Champus status for suggested values.
Definition: This field is defined by HCFA or other regulatory agencies.
Definition: Refer to HL7 table 0136 - Yes/no indicator for valid values.
Definition: Refer to HL7 table 0136 - Yes/no indicator for valid values.
Definition: Refer to HL7 table 0136 - Yes/no indicator for valid values.
Definition: Use this field instead of UB2-2-blood deductible, as the blood deductible can be associated with the specific insurance plan via this field.
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 individual who approves any special coverage. Multiple names for the same 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.
Definition: This field contains the title of the person who approves special coverage.
Definition: This field contains the code that describes why a service is not covered. Refer to user-defined table 0143 - Non-covered insurance code 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 field is required for NEIC processing, and it identifies the organization from which reimbursement is expected.
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 is required for NEIC processing, and it identifies the specific office within the insurance carrier that is designated as responsible for the claim.
Definition: This field is required for NEIC processing, and it identifies the source of information about the insureds eligibility for benefits. Refer to user-defined table 0144 - Eligibility source for suggested values.
User-defined Table 0144 - Eligibility source
Value |
Description |
1 |
Insurance company |
2 |
Employer |
3 |
Insured presented policy |
4 |
Insured presented card |
5 |
Signed statement on file |
6 |
Verbal information |
7 |
None |
Components: <room type (IS)> ^ <amount type (IS)> ^ <coverage amount(NM)>
Definition: Use this field instead of IN1-40-room rate - semi-private and IN1-41-room rate - private. This field contains room type (e.g., private, semi-private), amount type (e.g., limit, percentage) and amount covered by the insurance. Refer to user-defined tables 0145 - Room type and 0146 - Amount type for suggested values.
User-defined Table 0145 - Room type
Value |
Description |
PRI |
Private room |
2PRI |
Second private room |
SPR |
Semi-private room |
2SPR |
Second semi-private room |
ICU |
Intensive care unit |
2ICU |
Second intensive care unit |
User-defined Table 0146 - Amount type
Value |
Description |
DF |
Differential |
LM |
Limit |
PC |
Percentage |
RT |
Rate |
UL |
Unlimited |
Components: <policy type (IS)> ^ <amount class (IS)> ^ <amount (NM)>
Definition: This field contains the policy type (e.g., ancillary, major medical) and amount (e.g., amount, percentage, limit) covered by the insurance. Use this field instead of IN1-38-policy limit - amount. Refer to user-defined tables 0147 - Policy type and 0193 - Amount class for suggested values.
User-defined Table 0147 - Policy type
Value |
Description |
ANC |
Ancillary |
2ANC |
Second ancillary |
MMD |
Major medical |
2MMD |
Second major medical |
3MMD |
Third major medical |
User-defined Table 0193 - Amount class
Value |
Description |
AT |
Amount |
LM |
Limit |
PC |
Percentage |
UL |
Unlimited |
Components: <delay days (NM)> ^ <amount (NM)> ^ <number of days (NM)>
Definition: This field contains the number of days after which the daily deductible begins, the amount of the deductible, and the number of days to apply the deductible.
Definition: This field identifies the specific living conditions for the insured. Refer to user-defined table 0223- Living dependency for suggested values.
Definition: This field identifies the insureds state of mobility. Refer to user-defined table 0009 - Ambulatory status for suggested values.
Definition: This field contains the code that identifies the insureds citizenship. HL7 recommends using ISO table 3166 as the suggested vlues in user-defined table 0171 - Citizenship..
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 identifies the insureds primary speaking language. HL7 recommends using ISO table 639 as the suggested values in user-defined table 0296 - Language.
Definition: This field indicates the situation in which the insured person lives at his primary residence. Refer to user-defined table 0220 - Living arrangement for suggested values.
Definition: This field contains a user-defined code indicating what level of publicity is allowed (e.g., No Publicity, Family Only) for the insured. Refer to user-defined table 0215 - Publicity code for suggested values.
Definition: This field identifies the insureds protection, which determines whether or not access to information about this enrollee should be restricted from users who do not have adequate authority. Refer to HL7 table 0136 - Yes/no indicator for valid values.
Y restrict access
N do not restrict access
Definition: This field identifies whether the insured is currently a student or not, and whether the patient is a full-time or a part-time student. This field does not indicate the degree level (high school, college) of student, or his/her field of study (accounting, engineering, etc.). Refer to user-defined table 0231 - Student status for suggested values.
Definition: This field indicates the type of religion practiced by the insured. Refer to user-defined table 0006 - Religion 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 indicates the insureds mothers maiden name.
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 code that identifies the nation or national grouping to which the insured person belongs. This information may be different from a persons citizenship in countries in which multiple nationalities are recognized (for example, Spain: Basque, Catalan, etc.). HL7 recommends using ISO table 3166 as he suggested values in user-defined table 0212 - Nationality.
Definition: This field indicates the insureds ethnic group. ERISA has a published list of ethnic classifications that may be used by local agreement at a site. Refer to user-defined table 0189 - Ethnic group for suggested values.
Definition: This field contains the insureds marital status. Refer to user-defined table 0002 - Marital status for suggested values. Same values as those for PID-16-marital status.
Definition: This field indicates the date on which the insureds employment with a particular employer began.
Definition: This field indicates the date on which the persons employment with a particular employer ended.
Definition: This field contains a descriptive name for the insureds occupation (for example, Sr. Systems Analyst, Sr. Accountant).
Components: <job code (IS)> ^ <job class (IS)>
Definition: This field indicates a code that identifies the insureds job code ( for example, programmer, analyst, doctor, etc.). Refer to user-defined tables 0327 - Job code and 0328 - Job class for suggested values.
Definition: This field indicates a code that identifies the insureds current job status (for example, part time/workers comp, full-time/leave of absence, full-time/suspended, etc.). Refer to user-defined table 0311 - Job status 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 contact person that should be contacted at the insureds place of employment. (Joe Smith is the insured. He works at GTE. Contact Sue Jones at GTE regarding Joe Smiths policy). Multiple names for the same person may be sent in this sequence. 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 for 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 telephone number for Sue Jones who is the contact person at GTE (Joe Smiths place of employment). Joe Smith is the insured. Multiple phone numbers for the same contact person may be sent in this sequence, not multiple contacts. The primary telephone number is assumed to be in the first repetition. When no primary telephone number is sent, a repeat delimiter must be present for the first repetition. The components for this data type are described in Chapter 2.
Definition: This field contains the reason(s) that Sue Jones should be contacted on behalf of Joe Smith, a GTE employer. Refer to user-defined table 0222 - Contact reason 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 contact person for the insured. The components for 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 telephone number for the contact person for the insured. Multiple names for the same person may be sent in this contact, not multiple contacts. 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 for this data type are described in Chapter 2.
Definition: This field contains the reason(s) the person should be contacted regarding the insured. Refer to user-defined table - 0222 - Contact reason for suggested values.
Definition: This field indicates the date on which the insureds patient relationship (defined in IN1-17-insureds relationship to patient) became effective (began).
Definition: This field indicates the date after which the relationship (defined in IN1-17-insureds relationship to patient) is no longer effective.
Definition: This field contains a user-defined code that specifies how the contact should be used. Refer to user-defined table 0232 - Insurance company contact reason for suggested values.
User-defined Table 0232 - Insurance company contact reason
Value |
Description |
01 |
Medicare claim status |
02 |
Medicaid claim status |
03 |
name/address change |
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 telephone number of the person who should be contacted at the insurance company for questions regarding an insurance policy/claim, etc. Multiple phone numbers for the insurance company may be sent in this sequence. The primary telephone number is assumed to be in the first repetition. When the primary telephone number is not sent, a repeat delimiter must be sent first for the first repetition. The components for this data type are described in Chapter 2.
Definition: This field contains a user-defined code designating the extent of the coverage for a participating member (e.g., "single," "family," etc. Refer to user-defined table 0312 - Policy scope for suggested values.
Definition: This user-defined field identifies how the policy information got established. Refer to user-defined table 0313 - Policy source 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 field contains an identifying number assigned by the payor for each individual covered by the insurance policy issued to the insured. For example, each individual family member may have a different member number from the insurance policy number issued to the head of household.
Definition: This field specifies the relationship of the guarantor to the insurance subscriber. Refer to user-defined table 0063-Relationship for suggested values.
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: The value of this field represents the insureds telephone number. Multiple phone numbers may be sent in this sequence. The primary telephone number is assumed to be in the first repetition (PRN - Primary, PH - Telephone). When the primary telephone number is not sent, a repeat delimiter must be sent first for the first repetition. The components for 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: The value of this field represents the insureds employers telephone number. Multiple phone numbers may be sent in this sequence. The primary telephone number is assumed to be in the first repetition. When the primary telephone number is not sent, a repeat delimiter must be sent first for the first repetition. The components for this data type are described in Chapter 2.
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 indicates the Champus program for the handicapped in which the patient is enrolled.
Definition: This field indicates whether charges should be suspended for a patient. Refer to HL7 table 0136 - Yes/no indicator for valid values.
Y charges should be suspended
N charges should NOT be suspended
Definition: This field indicates if the patient has reached the co-pay limit so that no more co-pay charges should be calculated for the patient. Refer to HL7 table 0136 - Yes/no indicator for valid values.
Y the patient is at or exceeds the co-pay limit
N the patient is under the co-pay limit
Definition: This field indicates if the patient has reached the stoploss limit established in the Contract Master. Refer to HL7 table 0136 - Yes/no indicator for valid values.
Y the patient has reached the stoploss limit
N the patient has not reached the stoploss limit
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 indicates the name of the insured if the insured/subscriber is an organization. Multiple names for the insured may be sent in this sequence, not multiple insured people. 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 for this data type are described in Chapter 2.
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 indicates the name of the insureds employer, or the organization that purchased the insurance for the insured, if the employer is an organization. Multiple names and identifiers for the same organization may be sent in this field, not multiple organizations. 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 for this data type are described in Chapter 2.
Definition: ERISA has a published list of ethnic classifications that may be used by local agreement at a site. Refer to user-defined table 0005 - Race for suggested values.
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 indicates the relationship of the patient to the insured, as defined by HCFA or other regulatory agencies.