The Demo site for our new HL7 Version 2+ (plus) Standard
visit the hl7 website

Draft Website - For Review Purposes Only

IN1 - Insurance Segment

The IN1 segment contains insurance policy coverage information necessary to produce properly pro-rated and patient and insurance bills.

HL7 Attribute Table - IN1 - Insurance Segment
Seq# DataElement Description Must Implement Flags Cardinality Length C.LEN Vocabulary DataType
IN1
1 00426 Set ID - IN1 SHALL [1..1] [1..4] SI
2 00368 Health Plan ID SHALL [1..1] CWE
3 00428 Insurance Company ID SHALL [1..*] CX
4 00429 Insurance Company Name [0..*] XON
5 00430 Insurance Company Address [0..*] XAD
6 00431 Insurance Co Contact Person [0..*] XPN
7 00432 Insurance Co Phone Number [0..*] XTN
8 00433 Group Number = [0..1] 12 ST
9 00434 Group Name [0..*] XON
10 00435 Insured's Group Emp ID [0..*] CX
11 00436 Insured's Group Emp Name [0..*] XON
12 00437 Plan Effective Date [0..1] DT
13 00438 Plan Expiration Date [0..1] DT
14 00439 Authorization Information [0..1] AUI
15 00440 Plan Type [0..1] CWE
16 00441 Name Of Insured [0..*] XPN
17 00442 Insured's Relationship To Patient [0..1] CWE
18 00443 Insured's Date Of Birth [0..1] DTM
19 00444 Insured's Address [0..*] XAD
20 00445 Assignment Of Benefits [0..1] CWE
21 00446 Coordination Of Benefits [0..1] CWE
22 00447 Coord Of Ben. Priority = [0..1] 2 ST
23 00448 Notice Of Admission Flag [0..1] [1..1] ID
24 00449 Notice Of Admission Date [0..1] DT
25 00450 Report Of Eligibility Flag [0..1] [1..1] ID
26 00451 Report Of Eligibility Date [0..1] DT
27 00452 Release Information Code [0..1] CWE
28 00453 Pre-Admit Cert = [0..1] 15 ST
29 00454 Verification Date/Time [0..1] DTM
30 00455 Verification By [0..*] XCN
31 00456 Type Of Agreement Code [0..1] CWE
32 00457 Billing Status [0..1] CWE
33 00458 Lifetime Reserve Days = [0..1] 4 NM
34 00459 Delay Before L.R. Day = [0..1] 4 NM
35 00460 Company Plan Code [0..1] CWE
36 00461 Policy Number = [0..1] 15 ST
37 00462 Policy Deductible [0..1] CP
38 00463 Policy Limit - Amount SHALL NOT W [0..0]
39 00464 Policy Limit - Days = [0..1] 4 NM
40 00465 Room Rate - Semi-Private SHALL NOT W [0..0]
41 00466 Room Rate - Private SHALL NOT W [0..0]
42 00467 Insured's Employment Status [0..1] CWE
43 00468 Insured's Administrative Sex [0..1] CWE
44 00469 Insured's Employer's Address [0..*] XAD
45 00470 Verification Status = [0..1] 2 ST
46 00471 Prior Insurance Plan ID [0..1] CWE
47 01227 Coverage Type [0..1] CWE
48 00753 Handicap [0..1] CWE
49 01230 Insured's ID Number [0..*] CX
50 01854 Signature Code [0..1] CWE
51 01855 Signature Code Date [0..1] DT
52 01899 Insured's Birth Place [0..1] ST
53 01852 VIP Indicator [0..1] CWE
54 03292 External Health Plan Identifiers [0..*] CX
55 03335 Insurance Action Code [0..1] [1..*] ID

IN1-1: Set ID - IN1 (SI) 00426

Definition: IN1-1 - set ID - IN1 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. The Set ID in the IN1 segment is used to aggregate the grouping of insurance segments. For example, a patient with two insurance plans would have two groupings of insurance segments. IN1, IN2, and IN3 segments for Insurance Plan A with set ID 1, followed by IN1, IN2, and IN3 segments for Insurance Plan B, with set ID 2. There is no set ID in the IN2 segment because it is contained in the IN1, IN2, IN3 grouping, and is therefore not needed. The set ID in the IN3 segment is provided because there can be multiple repetitions of the IN3 segment if there are multiple certifications for the same insurance plan, e.g., IN1 (Set ID 1), IN2, IN3 (Set ID 1), IN3 (Set ID 2), IN3 (Set ID 3)

IN1-2: Health Plan ID (CWE) 00368

(Definition from FT1.14 in Ch. 6)

Definition: This field contains the identifier of the primary insurance plan with which this transaction should be associated. Refer to User-defined Table 0072 - Insurance Plan ID in Chapter 2C, Code Tables, for suggested values.

(Definition from IN1.2 in Ch. 6)

Definition: This field contains a unique identifier for the insurance plan. Refer to User-defined Table 0072 - Insurance Plan ID in Chapter 2C, Code Tables, for suggested values. To eliminate a plan, the plan could be sent with Delete Indication values in each subsequent element. If the respective systems can support it, a Delete Indication value can be sent in the plan field.

The assigning authority for IN1-2, Health Plan ID is assumed to be the Entity named in IN1-3, Insurance Company ID.

(Definition from PM1.1 in Ch. 8)

Definition: This field contains a unique identifier for the insurance plan. Refer to User-defined Table 0072 - Insurance Plan ID in Chapter 2C, Code Tables, for suggested values. 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.

The assigning authority for PM1-1, Health Plan ID is assumed to be the Entity named in PM1-2, Insurance Company ID.

IN1-3: Insurance Company ID (CX) 00428

(Definition from IN1.3 in Ch. 6)

Definition: This field contains unique identifiers for the insurance company. The assigning authority and identifier type code are strongly recommended for all CX data types.

(Definition from PM1.2 in Ch. 8)

Definition: This field contains unique identifiers for the insurance company. The assigning authority and identifier type code are strongly recommended for all CX data types.

IN1-4: Insurance Company Name (XON) 00429

(Definition from IN1.4 in Ch. 6)

Definition: This field contains the name of the insurance company. Multiple names for the same insurance company may be sent in this field. Specification of meaning based on sequence is deprecated.

(Definition from PM1.3 in Ch. 8)

Definition: This field contains the name of the insurance company. Multiple names for the same insurance company may be sent in this field.

IN1-5: Insurance Company Address (XAD) 00430

(Definition from IN1.5 in Ch. 6)

Definition: This field contains the address of the insurance company. Multiple addresses for the same insurance company 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.

(Definition from PM1.4 in Ch. 8)

Definition: This field contains the address of the insurance company. Multiple addresses for the same insurance company 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.

IN1-6: Insurance Co Contact Person (XPN) 00431

(Definition from IN1.6 in Ch. 6)

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

(Definition from PM1.5 in Ch. 8)

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

IN1-7: Insurance Co Phone Number (XTN) 00432

(Definition from IN1.7 in Ch. 6)

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

(Definition from PM1.6 in Ch. 8)

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

IN1-8: Group Number (ST) 00433

(Definition from IN1.8 in Ch. 6)

Definition: This field contains the group number of the insured's insurance.

(Definition from PM1.7 in Ch. 8)

Definition: This field contains the group number of the insured's insurance.

IN1-9: Group Name (XON) 00434

(Definition from IN1.9 in Ch. 6)

Definition: This field contains the group name of the insured's insurance.

(Definition from PM1.8 in Ch. 8)

Definition: This field contains the group name of the insured's insurance.

IN1-10: Insured's Group Emp ID (CX) 00435

Definition: This field holds the group employer ID for the insured's insurance. The assigning authority and identifier type code are strongly recommended for all CX data types.

IN1-11: Insured's Group Emp Name (XON) 00436

Definition: This field contains the name of the employer that provides the employee's insurance. Multiple names for the same employer may be sent in this sequence Specification of meaning based on sequence is deprecated.

IN1-12: Plan Effective Date (DT) 00437

(Definition from IN1.12 in Ch. 6)

Definition: This field contains the date that the insurance goes into effect.

(Definition from PM1.9 in Ch. 8)

Definition: This field contains the date that the insurance goes into effect.

IN1-13: Plan Expiration Date (DT) 00438

(Definition from IN1.13 in Ch. 6)

Definition: This field indicates the last date of service that the insurance will cover or be responsible for.

(Definition from PM1.10 in Ch. 8)

Definition: This field indicates the last date of service that the insurance will cover or be responsible for.

IN1-14: Authorization Information (AUI) 00439

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.

IN1-15: Plan Type (CWE) 00440

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

IN1-16: Name Of Insured (XPN) 00441

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

IN1-17: Insured's Relationship To Patient (CWE) 00442

Definition: This field indicates the insured's relationship to the patient. Refer to User-defined Table 0063 - Relationship in Chapter 2C, Code Tables, for suggested values.

IN1-18: Insured's Date Of Birth (DTM) 00443

Definition: This field contains the date of birth of the insured.

IN1-19: Insured's Address (XAD) 00444

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

IN1-20: Assignment Of Benefits (CWE) 00445

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

IN1-21: Coordination Of Benefits (CWE) 00446

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

IN1-22: Coord Of Ben. Priority (ST) 00447

Definition: If the insurance works in conjunction with other insurance plans, this field contains priority sequence. Values are: 1, 2, 3, etc.

IN1-23: Notice Of Admission Flag (ID) 00448

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

IN1-24: Notice Of Admission Date (DT) 00449

Definition: If a notice is required, this field indicates the date that it was sent.

IN1-25: Report Of Eligibility Flag (ID) 00450

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

IN1-26: Report Of Eligibility Date (DT) 00451

Definition: This field indicates whether a report of eligibility (ROE) was received, and also indicates the date that it was received.

IN1-27: Release Information Code (CWE) 00452

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

IN1-28: Pre-Admit Cert (ST) 00453

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.

IN1-29: Verification Date/Time (DTM) 00454

Definition: This field contains the date/time that the healthcare provider verified that the patient has the indicated benefits.

IN1-30: Verification By (XCN) 00455

Definition: Refers to the person who verified the benefits. Multiple names for the same insured person may be sent in this field Specification of meaning based on sequence is deprecated.

IN1-31: Type Of Agreement Code (CWE) 00456

Definition: This field is used to further identify an insurance plan. Refer to User-defined Table 0098 - Type of Agreement in Chapter 2C, Code Tables, for suggested values.

IN1-32: Billing Status (CWE) 00457

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

IN1-33: Lifetime Reserve Days (NM) 00458

Definition: This field contains the number of days left for a certain service to be provided or covered under an insurance policy.

IN1-34: Delay Before L.R. Day (NM) 00459

Definition: This field indicates the delay before lifetime reserve days.

IN1-35: Company Plan Code (CWE) 00460

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 in Chapter 2C, Code Tables, for suggested values. This table contains codes used to identify an insurance company plan uniquely.

IN1-36: Policy Number (ST) 00461

Definition: This field contains the individual policy number of the insured to uniquely identify this patient's plan. For special types of insurance numbers, there are also special fields in the IN2 segment for Medicaid, Medicare, Champus (i.e., IN2-6 - Medicare Health Ins Card Number, IN2-8 - Medicaid Case Number, IN2-10 - Military ID Number). But we recommend that this field (IN1-36 - Policy Number) be filled even when the patient's insurance number is also passed in one of these other fields.

IN1-37: Policy Deductible (CP) 00462

Definition: This field contains the amount specified by the insurance plan that is the responsibility of the guarantor (i.e., deductible, excess, etc.).

IN1-38: Policy Limit - Amount

Attention: IN1-38 was deprecated as of v 2.3 and the detail was withdrawn and removed from the standard as of v 2.6.

IN1-39: Policy Limit - Days (NM) 00464

Definition: This field contains the maximum number of days that the insurance policy will cover.

IN1-40: Room Rate - Semi-Private

Attention: IN1-40 was deprecated as of v 2.3 and the detail was withdrawn and removed from the standard as of v 2.6.

IN1-41: Room Rate - Private

Attention: IN1-41 was deprecated as of v 2.3 and the detail was withdrawn and removed from the standard as of v 2.6.

IN1-42: Insured's Employment Status (CWE) 00467

Definition: This field holds the employment status of the insured. Refer to User-defined Table 0066 - Employment Status in Chapter 2C, Code Tables, for suggested values. This field contains UB92 field 64. For this field element, values from the US CMS UB92 and others are used.

IN1-43: Insured's Administrative Sex (CWE) 00468

Definition: This field contains the gender of the insured. Refer to User-defined Table 0001 - Administrative Sex in Chapter 2C, Code Tables, for suggested values.

IN1-44: Insured's Employer's Address (XAD) 00469

Definition: This field contains the address of the insured employee's employer. Multiple addresses for the same employer 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.

IN1-45: Verification Status (ST) 00470

Definition: This field contains the status of this patient's relationship with this insurance carrier.

IN1-46: Prior Insurance Plan ID (CWE) 00471

Definition: This field uniquely identifies the prior insurance plan when the plan ID changes. Refer to User-defined Table 0072 - Insurance Plan ID in Chapter 2C, Code Tables, for suggested values.

IN1-47: Coverage Type (CWE) 01227

Definition: This field contains the coding structure that identifies the type of insurance coverage, or what types 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 that cover physician/professional charges. Refer to User-defined Table 0309 - Coverage Type in Chapter 2C, Code Tables, for suggested values.

IN1-48: Handicap (CWE) 00753

(Definition from NK1.36 in Ch. 3)

Definition: This field contains the code that describes an associated party's disability. Refer to User-defined Table 0295 - Handicap in Chapter 2C, Code Tables, for suggested values.

(Definition from PD1.6 in Ch. 3)

Definition: This field indicates the nature of the patient's permanent handicapped condition (e.g., deaf, blind). A handicapped condition is defined as a physical or mental disability that is permanent. Transient handicapped conditions should be sent in the ambulatory status. Refer to User-defined Table 0295 - Handicap in Chapter 2C, Code Tables, for suggested values.

(Definition from GT1.52 in Ch. 6)

Definition: This field contains a code to describe the guarantor's disability. Refer to User-defined Table 0295 - Handicap in Chapter 2C, Code Tables, for suggested values.

(Definition from IN1.48 in Ch. 6)

Definition: This field contains a code to describe the insured's disability. Refer to User-defined Table 0295 - Handicap in Chapter 2C, Code Tables, for suggested values.

IN1-49: Insured's ID Number (CX) 01230

Definition: This data element contains a healthcare institution's identifiers for the insured. The assigning authority and identifier type code are strongly recommended for all CX data types.

IN1-50: Signature Code (CWE) 01854

Definition: This field contains the code to indicate how the patient/subscriber authorization signature was obtained and how it is being retained by the provider. Refer to User-defined Table 0535 - Signature Code in Chapter 2C, Code Tables, for suggested values.

IN1-51: Signature Code Date (DT) 01855

Definition: The date the patient/subscriber authorization signature was obtained.

IN1-52: Insured's Birth Place (ST) 01899

Definition: This field contains the description of the insured's birth place, for example "St. Francis Community Hospital of Lower South Side." The actual address is reported in IN1-19 – Insured's Address with an identifier of "N".

IN1-53: VIP Indicator (CWE) 01852

Definition: This field identifies the type of VIP for the insured. Refer to User-defined Table 0099 – VIP Indicator in Chapter 2C, Code Tables, for suggested values.

IN1-54: External Health Plan Identifiers (CX) 03292

Definition: This field contains the external Health Plan Identifiers that correspond to the internal Health Plan ID in IN1-2 – Health Plan ID. The assigning authority and identifier type code are strongly recommended for al CX data types.

IN1-55: Insurance Action Code (ID) 03335

Definition: The Insurance Action Code Defines the action to be taken for this insurance. Refer to HL7 Table 0206 - Segment Action Code in Chapter 2C, Code Tables, for valid values. When this field is valued, the IN1, IN2, and IN3 are not in "snapshot mode", rather in "action mode".