18.8.64 IN2 - Insurance Additional Information Segment (6.5.7)

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

18.8.64.1 IN2 Field Definitions (6.5.7.0)

18.8.64.2 IN2-1 Insured's Employee ID (CX) 00472 (6.5.7.1)

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.

18.8.64.3 IN2-2 Insured's Social Security Number (ST) 00473 (6.5.7.2)

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

18.8.64.4 IN2-3 Insured's Employer's Name and ID (XCN) 00474 (6.5.7.3)

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.

18.8.64.5 IN2-4 Employer Information Data (CWE) 00475 (6.5.7.4)

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.

18.8.64.6 IN2-5 Mail Claim Party (CWE) 00476 (6.5.7.5)

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.

18.8.64.7 IN2-6 Medicare Health Ins Card Number (ST) 00477 (6.5.7.6)

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

18.8.64.8 IN2-7 Medicaid Case Name (XPN) 00478 (6.5.7.7)

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.

18.8.64.9 IN2-8 Medicaid Case Number (ST) 00479 (6.5.7.8)

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

18.8.64.10 IN2-9 Military Sponsor Name (XPN) 00480 (6.5.7.9)

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.

18.8.64.11 IN2-10 Military ID Number (ST) 00481 (6.5.7.10)

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

18.8.64.12 IN2-11 Dependent of Military Recipient (CWE) 00482 (6.5.7.11)

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.

18.8.64.13 IN2-12 Military Organization (ST) 00483 (6.5.7.12)

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

18.8.64.14 IN2-13 Military Station (ST) 00484 (6.5.7.13)

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

18.8.64.15 IN2-14 Military Service (CWE) 00485 (6.5.7.14)

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.

18.8.64.16 IN2-15 Military Rank/Grade (CWE) 00486 (6.5.7.15)

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.

18.8.64.17 IN2-16 Military Status (CWE) 00487 (6.5.7.16)

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

18.8.64.18 IN2-17 Military Retire Date (DT) 00488 (6.5.7.17)

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

18.8.64.19 IN2-18 Military Non-Avail Cert on File (ID) 00489 (6.5.7.18)

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

• YCertification on file

• NCertification not on file

18.8.64.20 IN2-19 Baby Coverage (ID) 00490 (6.5.7.19)

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

• YBaby coverage

• NNo baby coverage

18.8.64.21 IN2-20 Combine Baby Bill (ID) 00491 (6.5.7.20)

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

• YCombine bill

• NNormal billing

18.8.64.22 IN2-21 Blood Deductible (ST) 00492 (6.5.7.21)

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.

18.8.64.23 IN2-22 Special Coverage Approval Name (XPN) 00493 (6.5.7.22)

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.

18.8.64.24 IN2-23 Special Coverage Approval Title (ST) 00494 (6.5.7.23)

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

18.8.64.25 IN2-24 Non-Covered Insurance Code (CWE) 00495 (6.5.7.24)

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.

18.8.64.26 IN2-25 Payor ID (CX) 00496 (6.5.7.25)

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.

18.8.64.27 IN2-26 Payor Subscriber ID (CX) 00497 (6.5.7.26)

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.

18.8.64.28 IN2-27 Eligibility Source (CWE) 00498 (6.5.7.27)

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.

18.8.64.29 IN2-28 Room Coverage Type/Amount (RMC) 00499 (6.5.7.28)

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.

18.8.64.30 IN2-29 Policy Type/Amount (PTA) 00500 (6.5.7.29)

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.

18.8.64.31 IN2-30 Daily Deductible (DDI) 00501 (6.5.7.30)

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.

18.8.64.32 IN2-31 Living Dependency (CWE) 00755 (6.5.7.31)

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.

18.8.64.33 IN2-32 Ambulatory Status (CWE) 00145 (6.5.7.32)

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.

18.8.64.34 IN2-33 Citizenship (CWE) 00129 (6.5.7.33)

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.

18.8.64.35 IN2-34 Primary Language (CWE) 00118 (6.5.7.34)

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.

18.8.64.36 IN2-35 Living Arrangement (CWE) 00742 (6.5.7.35)

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.

18.8.64.37 IN2-36 Publicity Code (CWE) 00743 (6.5.7.36)

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.

18.8.64.38 IN2-37 Protection Indicator (ID) 00744 (6.5.7.37)

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.

• YRestrict access

• NDo not restrict access

18.8.64.39 IN2-38 Student Indicator (CWE) 00745 (6.5.7.38)

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.

18.8.64.40 IN2-39 Religion (CWE) 00120 (6.5.7.39)

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.

18.8.64.41 IN2-40 Mother's Maiden Name (XPN) 00109 (6.5.7.40)

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

18.8.64.42 IN2-41 Nationality (CWE) 00739 (6.5.7.41)

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.

18.8.64.43 IN2-42 Ethnic Group (CWE) 00125 (6.5.7.42)

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.

18.8.64.44 IN2-43 Marital Status (CWE) 00119 (6.5.7.43)

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.

18.8.64.45 IN2-44 Insured's Employment Start Date (DT) 00787 (6.5.7.44)

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

18.8.64.46 IN2-45 Employment Stop Date (DT) 00783 (6.5.7.45)

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

18.8.64.47 IN2-46 Job Title (ST) 00785 (6.5.7.46)

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

18.8.64.48 IN2-47 Job Code/Class (JCC) 00786 (6.5.7.47)

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

18.8.64.49 IN2-48 Job Status (CWE) 00752 (6.5.7.48)

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.

18.8.64.50 IN2-49 Employer Contact Person Name (XPN) 00789 (6.5.7.49)

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.

18.8.64.51 IN2-50 Employer Contact Person Phone Number (XTN) 00790 (6.5.7.50)

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.

18.8.64.52 IN2-51 Employer Contact Reason (CWE) 00791 (6.5.7.51)

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.

18.8.64.53 IN2-52 Insured's Contact Person's Name (XPN) 00792 (6.5.7.52)

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

18.8.64.54 IN2-53 Insured's Contact Person Phone Number (XTN) 00793 (6.5.7.53)

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.

18.8.64.55 IN2-54 Insured's Contact Person Reason (CWE) 00794 (6.5.7.54)

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

18.8.64.56 IN2-55 Relationship to the Patient Start Date (DT) 00795 (6.5.7.55)

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).

18.8.64.57 IN2-56 Relationship to the Patient Stop Date (DT) 00796 (6.5.7.56)

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

18.8.64.58 IN2-57 Insurance Co Contact Reason (CWE) 00797 (6.5.7.57)

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.

18.8.64.59 IN2-58 Insurance Co Contact Phone Number (XTN) 00798 (6.5.7.58)

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.

18.8.64.60 IN2-59 Policy Scope (CWE) 00799 (6.5.7.59)

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.

18.8.64.61 IN2-60 Policy source (CWE) 00800 (6.5.7.60)

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.

18.8.64.62 IN2-61 Patient Member Number (CX) 00801 (6.5.7.61)

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.

18.8.64.63 IN2-62 Guarantor's Relationship to Insured (CWE) 00802 (6.5.7.62)

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.

18.8.64.64 IN2-63 Insured's Phone Number - Home (XTN) 00803 (6.5.7.63)

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.

18.8.64.65 IN2-64 Insured's Employer Phone Number (XTN) 00804 (6.5.7.64)

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.

18.8.64.66 IN2-65 Military Handicapped Program (CWE) 00805 (6.5.7.65)

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.

18.8.64.67 IN2-66 Suspend Flag (ID) 00806 (6.5.7.66)

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.

• Ycharges should be suspended

• Ncharges should NOT be suspended

18.8.64.68 IN2-67 Copay Limit Flag (ID) 00807 (6.5.7.67)

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.

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

• Nthe patient is under the co-pay limit

18.8.64.69 IN2-68 Stoploss Limit Flag (ID) 00808 (6.5.7.68)

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.

• Ythe patient has reached the stoploss limit

• Nthe patient has not reached the stoploss limit

18.8.64.70 IN2-69 Insured Organization Name and ID (XON) 00809 (6.5.7.69)

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.

18.8.64.71 IN2-70 Insured Employer Organization Name and ID (XON) 00810 (6.5.7.70)

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.

18.8.64.72 IN2-71 Race (CWE) 00113 (6.5.7.71)

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.

18.8.64.73 IN2-72 Patient's Relationship to Insured (CWE) 00811 (6.5.7.72)

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.

18.8.64.74 IN2-73 Co-Pay Amount (CP) 01620 (6.5.7.73)

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