IN2 - Insurance Additional Information Segment

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 CMS or other regulatory agencies.

HL7 Attribute Table - IN2 - Insurance Additional Information Segment

Seq#	Data Element Name	DataType	Usage	Vocabulary	Cardinality	Item #	Length	C.LEN	Flags
IN2
1	Insured's Employee ID	CX	O		[0..*]	00472
2	Insured's Social Security Number	ST	O		[0..1]	00473		11	#
3	Insured's Employer's Name and ID	XCN	O		[0..*]	00474
4	Employer Information Data	CWE	O	0139 Employer Information Data	[0..1]	00475
5	Mail Claim Party	CWE	O	0137 Mail Claim Party	[0..*]	00476
6	Medicare Health Ins Card Number	ST	O		[0..1]	00477		15	#
7	Medicaid Case Name	XPN	O		[0..*]	00478
8	Medicaid Case Number	ST	O		[0..1]	00479		15	#
9	Military Sponsor Name	XPN	O		[0..*]	00480
10	Military ID Number	ST	O		[0..1]	00481		20	#
11	Dependent Of Military Recipient	CWE	O	0342 Military Recipient	[0..1]	00482
12	Military Organization	ST	O		[0..1]	00483		25	#
13	Military Station	ST	O		[0..1]	00484		25	#
14	Military Service	CWE	O	0140 Military Service	[0..1]	00485
15	Military Rank/Grade	CWE	O	0141 Military Rank/Grade	[0..1]	00486
16	Military Status	CWE	O	0142 Military Status	[0..1]	00487
17	Military Retire Date	DT	O		[0..1]	00488
18	Military Non-Avail Cert On File	ID	O	0136(R) Yes/no Indicator(Required)	[0..1]	00489	[1..1]
19	Baby Coverage	ID	O	0136(R) Yes/no Indicator(Required)	[0..1]	00490	[1..1]
20	Combine Baby Bill	ID	O	0136(R) Yes/no Indicator(Required)	[0..1]	00491	[1..1]
21	Blood Deductible	ST	O		[0..1]	00492		1	#
22	Special Coverage Approval Name	XPN	O		[0..*]	00493
23	Special Coverage Approval Title	ST	O		[0..1]	00494		30	#
24	Non-Covered Insurance Code	CWE	O	0143 Non-covered Insurance Code	[0..*]	00495
25	Payor ID	CX	O		[0..*]	00496
26	Payor Subscriber ID	CX	O		[0..*]	00497
27	Eligibility Source	CWE	O	0144 Eligibility Source	[0..1]	00498
28	Room Coverage Type/Amount	RMC	O		[0..*]	00499
29	Policy Type/Amount	PTA	O		[0..*]	00500
30	Daily Deductible	DDI	O		[0..1]	00501
31	Living Dependency	CWE	O	0223 Living Dependency	[0..1]	00755
32	Ambulatory Status	CWE	O	0009(S) Ambulatory Status(Suggested)	[0..*]	00145
33	Citizenship	CWE	O	0171 Citizenship	[0..*]	00129
34	Primary Language	CWE	O	0296 Primary Language	[0..1]	00118
35	Living Arrangement	CWE	O	0220 Living Arrangement	[0..1]	00742
36	Publicity Code	CWE	O	0215 Publicity Code	[0..1]	00743
37	Protection Indicator	ID	O	0136(R) Yes/no Indicator(Required)	[0..1]	00744	[1..1]
38	Student Indicator	CWE	O	0231(S) Student Status(Suggested)	[0..1]	00745
39	Religion	CWE	O	0006(S) Religion(Suggested)	[0..1]	00120
40	Mother's Maiden Name	XPN	O		[0..*]	00109
41	Nationality	CWE	O	0212 Nationality	[0..1]	00739
42	Ethnic Group	CWE	O	0189 Ethnic Group	[0..*]	00125
43	Marital Status	CWE	O	0002(S) Marital Status(Suggested)	[0..*]	00119
44	Insured's Employment Start Date	DT	O		[0..1]	00787
45	Employment Stop Date	DT	O		[0..1]	00783
46	Job Title	ST	O		[0..1]	00785		20	#
47	Job Code/Class	JCC	O	0327 Job Code	[0..1]	00786
48	Job Status	CWE	O	0311 Job Status	[0..1]	00752
49	Employer Contact Person Name	XPN	O		[0..*]	00789
50	Employer Contact Person Phone Number	XTN	O		[0..*]	00790
51	Employer Contact Reason	CWE	O	0222 Contact Reason	[0..1]	00791
52	Insured's Contact Person's Name	XPN	O		[0..*]	00792
53	Insured's Contact Person Phone Number	XTN	O		[0..*]	00793
54	Insured's Contact Person Reason	CWE	O	0222 Contact Reason	[0..*]	00794
55	Relationship to the Patient Start Date	DT	O		[0..1]	00795
56	Relationship to the Patient Stop Date	DT	O		[0..*]	00796
57	Insurance Co Contact Reason	CWE	O	0232 - Insurance Company Contact Reason	[0..1]	00797
58	Insurance Co Contact Phone Number	XTN	O		[0..*]	00798
59	Policy Scope	CWE	O	0312 Policy Scope	[0..1]	00799
60	Policy Source	CWE	O	0313 Policy Source	[0..1]	00800
61	Patient Member Number	CX	O		[0..1]	00801
62	Guarantor's Relationship to Insured	CWE	O	0063 Relationship	[0..1]	00802
63	Insured's Phone Number - Home	XTN	O		[0..*]	00803
64	Insured's Employer Phone Number	XTN	O		[0..*]	00804
65	Military Handicapped Program	CWE	O	0343 Military Handicapped Program Code	[0..1]	00805
66	Suspend Flag	ID	O	0136(R) Yes/no Indicator(Required)	[0..1]	00806	[1..1]
67	Copay Limit Flag	ID	O	0136(R) Yes/no Indicator(Required)	[0..1]	00807	[1..1]
68	Stoploss Limit Flag	ID	O	0136(R) Yes/no Indicator(Required)	[0..1]	00808	[1..1]
69	Insured Organization Name and ID	XON	O		[0..*]	00809
70	Insured Employer Organization Name and ID	XON	O		[0..*]	00810
71	Race	CWE	O	0005(S) Race(Suggested)	[0..*]	00113
72	Patient's Relationship to Insured	CWE	O	0344(S) Patient's Relationship to Insured(Suggested)	[0..1]	00811
73	Co-Pay Amount	CP	O		[0..1]	01620

IN2-1: Insured's Employee ID (CX) 00472

Definition: This field contains the employee ID of the insured. The assigning authority and identifier type code are strongly recommended for all CX data types.

IN2-2: Insured's Social Security Number (ST) 00473

Definition: This field contains the social security number of the insured.

IN2-3: Insured's Employer's Name and ID (XCN) 00474

Definition: This field contains the name and ID of the insured's employer or the person who purchased the insurance for the insured, if the employer is a person. Multiple names and identifiers for the same person may be sent in this field, not multiple persons Specification of meaning based on sequence is deprecated. When the employer is an organization use IN2-70 - Insured Employer Organization Name and ID.

IN2-4: Employer Information Data (CWE) 00475

Definition: This field contains the required employer information data for UB82 form locator 71. Refer to User-defined Table 0139 - Employer Information Data in Chapter 2C, Code Tables, for suggested values.

IN2-5: Mail Claim Party (CWE) 00476

Definition: This field contains the party to which the claim should be mailed. Refer to User-defined Table 0137 - Mail Claim Party in Chapter 2C, Code Tables, for suggested values.

IN2-6: Medicare Health Ins Card Number (ST) 00477

Definition: This field contains the Medicare Health Insurance Number (HIN), defined by CMS or other regulatory agencies.

IN2-7: Medicaid Case Name (XPN) 00478

Definition: This field contains the Medicaid case name, defined by CMS or other regulatory agencies. Multiple names for the same person may be sent in this field. As of v 2.7, no assumptions can be made based on position or sequence. Specification of meaning based on sequence is deprecated.

IN2-8: Medicaid Case Number (ST) 00479

Definition: This field contains the Medicaid case number, defined by CMS or other regulatory agencies, which uniquely identifies a patient's Medicaid policy.

IN2-9: Military Sponsor Name (XPN) 00480

Definition: This field is defined by CMS or other regulatory agencies. Multiple names for the same person may be sent in this field. Specification of meaning based on sequence is deprecated.

IN2-10: Military ID Number (ST) 00481

Definition: This field contains the military ID number, defined by CMS or other regulatory agencies, which uniquely identifies a patient's military policy.

IN2-11: Dependent Of Military Recipient (CWE) 00482

Definition: This field is defined by CMS or other regulatory agencies. Refer to User-defined Table 0342 - Military Recipient in Chapter 2C, Code Tables, for suggested values.

IN2-12: Military Organization (ST) 00483

Definition: This field is defined by CMS or other regulatory agencies.

IN2-13: Military Station (ST) 00484

Definition: This field is defined by CMS or other regulatory agencies.

IN2-14: Military Service (CWE) 00485

Definition: This field is defined by CMS or other regulatory agencies and refers to the military branch of service. Refer to User-defined Table 0140 - Military Service in Chapter 2C, Code Tables, for suggested values. The UB codes listed may not represent a complete list; refer to a UB specification for additional information.

IN2-15: Military Rank/Grade (CWE) 00486

Definition: This user-defined field identifies the military rank/grade of the insured. Refer to User-defined Table 0141 - Military Rank/Grade in Chapter 2C, Code Tables, for suggested values.

IN2-16: Military Status (CWE) 00487

Definition: This field is defined by CMS or other regulatory agencies. Refer to User-defined Table 0142 - Military Status in Chapter 2C, Code Tables, for suggested values. The UB codes listed may not represent a complete list; refer to a UB specification for additional information

IN2-17: Military Retire Date (DT) 00488

Definition: This field is defined by CMS or other regulatory agencies.

IN2-18: Military Non-Avail Cert On File (ID) 00489

Definition: Refer to HL7 Table 0136 - Yes/no Indicator in Chapter 2C, Code Tables, for valid values.

• Y    Certification on file

• N    Certification not on file

IN2-19: Baby Coverage (ID) 00490

Definition: Refer to HL7 Table 0136 - Yes/no Indicator in Chapter 2C, Code Tables, for valid values.

• Y    Baby coverage

• N    No baby coverage

IN2-20: Combine Baby Bill (ID) 00491

Definition: Refer to HL7 Table 0136 - Yes/no Indicator in Chapter 2C, Code Tables, for valid values.

• Y    Combine bill

• N    Normal billing

IN2-21: Blood Deductible (ST) 00492

Definition: Use this field instead of UB1-2 - Blood Deductible, as the blood deductible can be associated with the specific insurance plan via this field.

IN2-22: Special Coverage Approval Name (XPN) 00493

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. As of v 2.7, no assumptions can be made based on position or sequence. Specification of meaning based on sequence is deprecated.

IN2-23: Special Coverage Approval Title (ST) 00494

Definition: This field contains the title of the person who approves special coverage.

IN2-24: Non-Covered Insurance Code (CWE) 00495

Definition: This field contains the code that describes why a service is not covered. Refer to User-defined Table 0143 - Non-covered Insurance Code in Chapter 2C, Code Tables, for suggested values.

IN2-25: Payor ID (CX) 00496

Definition: In the US this field is required for ENVOY Corporation (a US claims clearing house) processing, and it identifies the organization from which reimbursement is expected. This field can also be used to report the National Health Plan ID. The assigning authority and identifier type code are strongly recommended for all CX data types.

IN2-26: Payor Subscriber ID (CX) 00497

Definition: In the US this field is required for ENVOY Corporation processing, and it identifies the specific office within the insurance carrier that is designated as responsible for the claim. The assigning authority and identifier type code are strongly recommended for all CX data types.

IN2-27: Eligibility Source (CWE) 00498

Definition: In the US this field is required for ENVOY Corporation processing, and it identifies the source of information about the insured's eligibility for benefits. Refer to User-defined Table 0144 - Eligibility Source in Chapter 2C, Code Tables, for suggested values.

IN2-28: Room Coverage Type/Amount (RMC) 00499

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.

IN2-29: Policy Type/Amount (PTA) 00500

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.

IN2-30: Daily Deductible (DDI) 00501

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.

If "number of days" is not valued, the deductible is ongoing.

IN2-31: Living Dependency (CWE) 00755

Definition: This field identifies the specific living conditions for the insured. Refer to User-defined Table 0223 - Living Dependency in Chapter 2C, Code Tables, for suggested values.

IN2-32: Ambulatory Status (CWE) 00145

Definition: This field identifies the insured's state of mobility. Refer to User-defined Table 0009 - Ambulatory Status in Chapter 2C, Code Tables, for suggested values.

IN2-33: Citizenship (CWE) 00129

Definition: This field contains the code that identifies the insured's citizenship. HL7 recommends using ISO table 3166 as the suggested values in User-defined Table 0171 - Citizenship defined in Chapter 2C, Code Tables.

IN2-34: Primary Language (CWE) 00118

Definition: This field identifies the insured's primary speaking language. HL7 recommends using ISO table 639 as the suggested values in User-defined Table 0296 - Primary Language defined in Chapter 2C, Code Tables.

IN2-35: Living Arrangement (CWE) 00742

Definition: This field indicates the situation in which the insured person lives at his primary residence. Refer to User-defined Table 0220 - Living Arrangement in Chapter 2C, Code Tables, for suggested values.

IN2-36: Publicity Code (CWE) 00743

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 in Chapter 2C, Code Tables, for suggested values.

IN2-37: Protection Indicator (ID) 00744

Definition: This field identifies the insured's 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 in Chapter 2C, Code Tables, for valid values.

• Y    Restrict access

• N    Do not restrict access

IN2-38: Student Indicator (CWE) 00745

Definition: This field identifies whether the insured is currently a student or not, and whether the insured 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 in Chapter 2C, Code Tables, for suggested values.

IN2-39: Religion (CWE) 00120

Definition: This field indicates the type of religion practiced by the insured. Refer to User-defined Table 0006 - Religion in Chapter 2C, Code Tables, for suggested values.

IN2-40: Mother's Maiden Name (XPN) 00109

Definition: This field indicates the insured's mother's maiden name.

IN2-41: Nationality (CWE) 00739

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 person's citizenship in countries in which multiple nationalities are recognized (for example, Spain: Basque, Catalan, etc.). HL7 recommends using ISO table 3166 as the suggested values in User-defined Table 0212 - Nationality in Chapter 2C, Code Tables.

IN2-42: Ethnic Group (CWE) 00125

Definition: This field indicates the insured's ethnic group. Refer to User-defined Table 0189 - Ethnic Group in Chapter 2C, Code Tables, for suggested values. The second triplet of the CE data type for ethnic group (alternate identifier, alternate text, and name of alternate coding system) is reserved for governmentally assigned codes. In the US, a current use is to report ethnicity in line with US federal standards for Hispanic origin.

IN2-43: Marital Status (CWE) 00119

Definition: This field contains the insured's marital status. Refer to User-defined Table 0002 - Marital Status in Chapter 2C, Code Tables, for suggested values.

IN2-44: Insured's Employment Start Date (DT) 00787

Definition: This field indicates the date on which the insured's employment with a particular employer began.

IN2-45: Employment Stop Date (DT) 00783

Definition: This field indicates the date on which the person's employment with a particular employer ended.

IN2-46: Job Title (ST) 00785

Definition: This field contains a descriptive name for the insured's occupation (for example, Sr. Systems Analyst, Sr. Accountant).

IN2-47: Job Code/Class (JCC) 00786

Definition: This field indicates a code that identifies the insured's job code (for example, programmer, analyst, doctor, etc.).

IN2-48: Job Status (CWE) 00752

Definition: This field indicates a code that identifies the insured's current job status. Refer to User-defined Table 0311 - Job Status in Chapter 2C, Code Tables, for suggested values.

IN2-49: Employer Contact Person Name (XPN) 00789

Definition: This field contains the name of the contact person that should be contacted at the insured's place of employment. (Joe Smith is the insured. He works at GTE. Contact Sue Jones at GTE regarding Joe Smith's policy). Multiple names for the same person may be sent in this sequence. As of v 2.7, no assumptions can be made based on position or sequence. Specification of meaning based on sequence is deprecated.

IN2-50: Employer Contact Person Phone Number (XTN) 00790

Definition: This field contains the telecommunications contact for the employer contact person. Multiple phone numbers for the same contact person may be sent in this sequence, not multiple contacts. As of v 2.7, no assumptions can be made based on position or sequence. Specification of meaning based on sequence is deprecated.

IN2-51: Employer Contact Reason (CWE) 00791

Definition: Definition: This field contains the reason(s) that employer contact person should be contacted on behalf of the employee. Refer to User-defined Table 0222 - Contact Reason in Chapter 2C, Code Tables, for suggested values.

IN2-52: Insured's Contact Person's Name (XPN) 00792

Definition: This field contains the contact person for the insured.

IN2-53: Insured's Contact Person Phone Number (XTN) 00793

Definition: This field contains the telephone number for the contact person for the insured. Multiple phone numbers for the same person may be sent in this contact, not multiple contacts. As of v 2.7, no assumptions can be made based on position or sequence. Specification of meaning based on sequence is deprecated.

IN2-54: Insured's Contact Person Reason (CWE) 00794

Definition: This field contains the reason(s) the person should be contacted regarding the insured. Refer to User-defined Table 0222 - Contact Reason in Chapter 2C, Code Tables, for suggested values

IN2-55: Relationship to the Patient Start Date (DT) 00795

Definition: This field indicates the date on which the insured's patient relationship (defined in IN1-17 - Insured's Relationship to Patient) became effective (began).

IN2-56: Relationship to the Patient Stop Date (DT) 00796

Definition: This field indicates the date after which the relationship (defined in IN1-17 - Insured's Relationship to Patient) is no longer effective.

IN2-57: Insurance Co Contact Reason (CWE) 00797

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 in Chapter 2C, Code Tables, for suggested values.

IN2-58: Insurance Co Contact Phone Number (XTN) 00798

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. As of v 2.7, no assumptions can be made based on position or sequence. Specification of meaning based on sequence is deprecated.

IN2-59: Policy Scope (CWE) 00799

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 in Chapter 2C, Code Tables, for suggested values.

IN2-60: Policy Source (CWE) 00800

Definition: This user-defined field identifies how the policy information got established. Refer to User-defined Table 0313 - Policy Source in Chapter 2C, Code Tables, for suggested values.

IN2-61: Patient Member Number (CX) 00801

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. The assigning authority and identifier type code are strongly recommended for all CX data types.

IN2-62: Guarantor's Relationship to Insured (CWE) 00802

Definition: This field specifies the relationship of the guarantor to the insurance subscriber. Refer to User-defined Table 0063 - Relationship in Chapter 2C, Code Tables, for suggested values.

IN2-63: Insured's Phone Number - Home (XTN) 00803

Definition: The value of this field represents the insured's telephone number. Multiple phone numbers may be sent in this sequence. As of v 2.7, no assumptions can be made based on position or sequence. Specification of meaning based on sequence is deprecated.

IN2-64: Insured's Employer Phone Number (XTN) 00804

Definition: The value of this field represents the insured's employer's telephone number. Multiple phone numbers may be sent in this sequence. As of v 2.7, no assumptions can be made based on position or sequence. Specification of meaning based on sequence is deprecated.

IN2-65: Military Handicapped Program (CWE) 00805

Definition: This field indicates the military program for the handicapped in which the patient is enrolled. Refer to User-defined Table 0343 - Military Handicapped Program Code in Chapter 2C, Code Tables, for suggested values.

IN2-66: Suspend Flag (ID) 00806

Definition: This field indicates whether charges should be suspended for a patient. Refer to HL7 Table 0136 - Yes/no Indicator in Chapter 2C, Code Tables, for valid values.

• Y    charges should be suspended

• N    charges should NOT be suspended

IN2-67: Copay Limit Flag (ID) 00807

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 in Chapter 2C, Code Tables, for valid values.

• Y    the patient is at or exceeds the co-pay limit

• N    the patient is under the co-pay limit

IN2-68: Stoploss Limit Flag (ID) 00808

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 in Chapter 2C, Code Tables, for valid values.

• Y    the patient has reached the stoploss limit

• N    the patient has not reached the stoploss limit

IN2-69: Insured Organization Name and ID (XON) 00809

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 Specification of meaning based on sequence is deprecated.

IN2-70: Insured Employer Organization Name and ID (XON) 00810

Definition: This field indicates the name of the insured's 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. Specification of meaning based on sequence is deprecated.

IN2-71: Race (CWE) 00113

Definition: Refer to User-defined Table 0005 - Race in Chapter 2C, Code Tables, for suggested values. The second triplet of the CE data type for race (alternate identifier, alternate text, and name of alternate coding system) is reserved for governmentally assigned codes.

IN2-72: Patient's Relationship to Insured (CWE) 00811

Definition: This field indicates the relationship of the patient to the insured, as defined by CMS or other regulatory agencies. Refer to User-defined Table 0344 - Patient's Relationship to Insured in Chapter 2C, Code Tables, for suggested values. The UB codes listed may not represent a complete list; refer to a UB specification for additional information.

IN2-73: Co-Pay Amount (CP) 01620

Definition: This field contains the patient's Co-pay amount for visit.