The IN3 segment contains additional insurance information for certifying the need for patient care. Fields used by this segment are defined by HCFA, or other regulatory agencies.
Figure 6-8. IN3 attributes
SEQ |
LEN |
DT |
OPT |
RP/# |
TBL# |
ITEM# |
ELEMENT NAME |
1 |
4 |
SI |
R |
00502 |
Set ID - IN3 |
||
2 |
59 |
CX |
O |
00503 |
Certification Number |
||
3 |
60 |
XCN |
O |
Y |
00504 |
Certified By |
|
4 |
1 |
ID |
O |
0136 |
00505 |
Certification Required |
|
5 |
10 |
CM |
O |
0148 |
00506 |
Penalty |
|
6 |
26 |
TS |
O |
00507 |
Certification Date/Time |
||
7 |
26 |
TS |
O |
00508 |
Certification Modify Date/Time |
||
8 |
60 |
XCN |
O |
Y |
00509 |
Operator |
|
9 |
8 |
DT |
O |
00510 |
Certification Begin Date |
||
10 |
8 |
DT |
O |
00511 |
Certification End Date |
||
11 |
3 |
CM |
O |
0149 |
00512 |
Days |
|
12 |
60 |
CE |
O |
0233 |
00513 |
Non-Concur Code/Description |
|
13 |
26 |
TS |
O |
00514 |
Non-Concur Effective Date/Time |
||
14 |
60 |
XCN |
O |
Y |
00515 |
Physician Reviewer |
|
15 |
48 |
ST |
O |
00516 |
Certification Contact |
||
16 |
40 |
XTN |
O |
Y |
00517 |
Certification Contact Phone Number |
|
17 |
60 |
CE |
O |
00518 |
Appeal Reason |
||
18 |
60 |
CE |
O |
00519 |
Certification Agency |
||
19 |
40 |
XTN |
O |
Y |
00520 |
Certification Agency Phone Number |
|
20 |
40 |
CM |
O |
Y |
00521 |
Pre-Certification Req/Window |
|
21 |
48 |
ST |
O |
00522 |
Case Manager |
||
22 |
8 |
DT |
O |
00523 |
Second Opinion Date |
||
23 |
1 |
IS |
O |
0151 |
00524 |
Second Opinion Status |
|
24 |
1 |
IS |
O |
Y |
0152 |
00525 |
Second Opinion Documentation Received |
25 |
60 |
XCN |
O |
Y |
00526 |
Second Opinion Physician |
6.4.8.0 IN3 field definitions
Definition: IN3-1-set ID contains the number that identifies this transaction. For the first occurrence of the segment the sequence number shall be 1, for the second occurrence it shall be 2, etc.
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 the number assigned by the certification agency.
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 party that approved the certification. Multiple names and identifiers 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 of this field are described in Chapter 2.
Definition: This field indicates whether certification is required. Refer to HL7 table 0136 - Yes/no indicator for valid values.
Components: <penalty type (IS)> ^ <penalty amount (NM)>
Definition: This field contains the penalty, in dollars or a percentage, that will be assessed if the pre-certification is not performed. Refer to user-defined table 0148 - Penalty type for suggested values.
User-defined Table 0148 - Penalty type
Value |
Description |
AT PC |
Currency amount Percentage |
Definition: This field contains the date and time stamp that indicates when insurance was certified to exist for the patient.
Definition: This field contains the date/time that the certification was modified.
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 party that is responsible for sending this certification information. 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 of this field are described in Chapter 2.
Definition: This field contains the date that this certification begins.
Definition: This field contains date that this certification ends.
Components: <day type (IS)> ^ <number of days (NM)>
Definition: This field contains the number of days for which this certification is valid. This field applies to denied, pending, or approved days. Refer to user-defined table 0149 - Day type for suggested values.
User-defined Table 0149 - Day type
Value |
Description |
AP |
Approved |
DE |
Denied |
PE |
Pending |
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 the non-concur code and description for a denied request. Refer to user-defined table 0233 - Non-concur code/description for suggested values.
Definition: This field contains the effective date of the non-concurrence classification.
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 physician who works with and reviews cases that are pending physician review for the certification agency. 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 of this field are described in Chapter 2.
Definition: This field contains the name of the party contacted at the certification agency who granted the certification and communicated the certification number.
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 certification contact. Multiple phone numbers for the same certification contact may be sent in this sequence. The primary phone 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 of this field 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 contains the reason that an appeal was made on a non-concur for certification.
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 the certification agency.
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 certification agency. The components of this field are described in Chapter 2.
Components: <pre-certification patient type (IS)> ^ <pre-certification required (ID)> ^ <pre-certification window (TS)>
Definition: This field indicates whether pre-certification is required for particular patient types, and the time window for obtaining the certification. The following components of this field are defined as follows:
pre-certification patient type refers to user-defined table 0150 - Pre-certification patient type for suggested values
pre-certification required refers to HL7 table 0136 - Yes/no indicator for valid values
pre-certification window is the amount of time required to attain certification from arrival at the institution. Its format follows the time stamp (TS) data type rules.
User-defined Table 0150 - Pre-certification patient type
Value |
Description |
ER |
Emergency |
IPE |
Inpatient elective |
OPE |
Outpatient elective |
UR |
Urgent |
Definition: This field contains the entity who/which is handling this particular patients case (e.g., UR nurse, or a specific facility location).
Definition: This field contains the date that the second opinion was obtained.
Definition: This field contains the code that represents the status of the second opinion. Refer to user-defined table 0151 - Second opinion status for suggested values.
Definition: Use this field if accompanying documentation has been received by the provider. Refer to user-defined table 0152 - Second opinion documentation received for suggested values.
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 an identifier and name of the physician who provided the second opinion. Multiple names and identifiers 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 of this field are described in Chapter 2.