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

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.

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

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.

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.

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.

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

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.

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

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.

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

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.

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

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

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.

(Definition from PD1.20 in Ch. 3)

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

(Definition from IN2.15 in Ch. 6)

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.

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

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

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

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

• Y    Baby coverage

• N    No baby coverage

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

• Y    Combine bill

• N    Normal billing

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.

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.

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

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.

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.

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.

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.

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.

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.

(Definition from NK1.17 in Ch. 3)

Definition: This field identifies specific living conditions (e.g., spouse dependent on patient, walk-up) that are relevant to an evaluation of the patient's healthcare needs. This information can be used for discharge planning. Examples might include Spouse Dependent, Medical Supervision Required, Small Children Dependent. This field repeats because, for example, "spouse dependent" and "medical supervision required" can apply at the same time. Refer to User-defined Table 0223 - Living Dependency in Chapter 2C, Code Tables, for suggested values.

(Definition from PD1.1 in Ch. 3)

Definition: This field identifies specific living conditions (e.g., spouse dependent on patient, walk-up) that are relevant to an evaluation of the patient's healthcare needs. This information can be used for discharge planning. This field repeats because, for example, "spouse dependent" and "medical supervision required" can apply at the same time. Refer to User-defined Table 0223 - Living Dependency in Chapter 2C, Code Tables, for suggested values.

(Definition from GT1.33 in Ch. 6)

Definition: Identifies the specific living conditions of the guarantor. Refer to User-defined Table 0223 - Living Dependency in Chapter 2C, Code Tables, for suggested values.

(Definition from IN2.31 in Ch. 6)

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.

(Definition from PV1.15 in Ch. 3)

Definition: This field indicates any permanent or transient handicapped conditions. Refer to User-defined Table 0009 - Ambulatory Status in Chapter 2C, Code Tables, for suggested entries.

(Definition from NK1.18 in Ch. 3)

Definition: This field identifies the transient rate of mobility for the next of kin/associated party. Refer to User-defined Table 0009 - Ambulatory Status in Chapter 2C, Code Tables for suggested values.

(Definition from GT1.34 in Ch. 6)

Definition: Identifies the transient state of mobility for the guarantor. Refer to User-defined Table 0009 - Ambulatory Status in Chapter 2C, Code Tables, for suggested values.

(Definition from IN2.32 in Ch. 6)

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.

(Definition from PID.26 in Ch. 3)

This field contains the information related to a person's country citizenship. For country citizenship HL7 recommends using ISO table 3166. For a local definition, User-defined Table 0171 - Citizenship in Chapter 2C, Code Tables, should be used.

This field repeats since persons can be citizens of more than one country. The Name of Coding System component(s) of the CWE datatype should be used to identify the table from which citizenship membership is drawn.

In the Netherlands, this field is used for "Nationaliteit".

(Definition from NK1.19 in Ch. 3)

Definition: This field contains the code to identify the next of kin/associated party's citizenship. HL7 recommends using ISO 3166 as the suggested values in User-defined Table 0171 - Citizenship in Chapter 2C, Code Tables.

(Definition from GT1.35 in Ch. 6)

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

(Definition from IN2.33 in Ch. 6)

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.

(Definition from STF.30 in Ch. 15)

Definition: This field contains the staff person's current country of citizenship. HL7 recommends using ISO table 3166 as the suggested values in User-defined Table 0171 - Citizenship (in Chapter 2C, Code Tables).

(Definition from PID.15 in Ch. 3)

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

(Definition from NK1.20 in Ch. 3)

Definition: This field identifies the next of kin/associated party's primary speaking language. HL7 recommends using ISO 639 as the suggested values in User-defined Table 0296 - Language in Chapter 2C, Code Tables.

(Definition from GT1.36 in Ch. 6)

Definition: This field identifies the guarantor'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.

(Definition from IN2.34 in Ch. 6)

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.

(Definition from NK1.21 in Ch. 3)

Definition: This field identifies the situation that the associated party lives in at his/her residential address. Refer to User-defined Table 0220 - Living Arrangement in Chapter 2C, Code Tables, for suggested values.

(Definition from PD1.2 in Ch. 3)

Definition: This field identifies the situation in which the patient lives at his residential address. Examples might include Alone, Family, Relatives, Institution, etc. Refer to User-defined Table 0220 - Living Arrangement in Chapter 2C, Code Tables, for suggested values.

(Definition from GT1.37 in Ch. 6)

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

(Definition from IN2.35 in Ch. 6)

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.

(Definition from NK1.22 in Ch. 3)

Definition: This field indicates what level of publicity is allowed (e.g., No Publicity, Family Only) for the next of kin/associated party. Refer to User-defined Table 0215 - Publicity Code in Chapter 2C, Code Tables, for suggested values.

(Definition from PD1.11 in Ch. 3)

Definition: This field contains a user-defined code indicating what level of publicity is allowed (e.g., No Publicity, Family Only) for the patient. Refer to User-defined Table 0215 - Publicity Code in Chapter 2C, Code Tables, for suggested values. Refer to PV2-21 - Visit Publicity Code for visit level code.

(Definition from GT1.38 in Ch. 6)

Definition: This field contains a user-defined code indicating what level of publicity is allowed (e.g., No Publicity, Family Only) for a guarantor. Refer to User-defined Table 0215 - Publicity Code in Chapter 2C, Code Tables, for suggested values.

(Definition from IN2.36 in Ch. 6)

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.

(Definition from NK1.23 in Ch. 3)

Definition: This field identifies that next of kin/associated party's protection that determines, in turn, whether access to information about this person should be kept 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    protect access to next-of-kin information

• N    normal access

(Definition from PD1.12 in Ch. 3)

Definition: From V2.6 onward, this field has been retained for backward compatibility only. Use the ARV segment instead. This field identifies the patient's protection that determines, in turn, whether access to information about this person should be kept from users who do not have adequate authority for the patient. Refer to HL7 Table 0136 - Yes/No Indicator in Chapter 2C, Code Tables, for valid values.

• Y    protect access to information

• N    normal access

Refer to PV2-22 - Visit Protection Indicator for visit level code.

(Definition from GT1.39 in Ch. 6)

Definition: This field identifies the guarantor'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 for valid values.

• Y    restrict access

• N    do not restrict access

(Definition from IN2.37 in Ch. 6)

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

(Definition from NK1.24 in Ch. 3)

Definition: This field identifies whether the next of kin/associated party is currently a student or not, and whether the next of kin/associated party is a full- or a part-time student. This field does not indicate the degree (high school, college) of the student or the field of study. Refer to User-defined Table 0231 - Student Status in chapter 2C, for suggested values.

(Definition from PD1.5 in Ch. 3)

Definition: This field indicates if the patient 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 student's degree level (high school, college, elementary) or the student's field of study (accounting, engineering, etc.). Refer to User-defined Table 0231 - Student Status in chapter 2C, for suggested values.

(Definition from GT1.40 in Ch. 6)

Definition: This field indicates whether the guarantor is currently a student, and whether the guarantor is a full-time or part-time student. This field does not indicate the degree level (high school, college) of the 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.

(Definition from IN2.38 in Ch. 6)

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.

(Definition from PID.17 in Ch. 3)

Definition: This field contains the patient's religion. Refer to User-defined Table 0006 - Religion in Chapter 2C, Code Tables, for suggested values.

(Definition from NK1.25 in Ch. 3)

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

(Definition from GT1.41 in Ch. 6)

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

(Definition from IN2.39 in Ch. 6)

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.

(Definition from STF.40 in Ch. 15)

Definition: This field contains the staff member's religion. Refer to User-defined Table 0006 - Religion in Chapter 2C, Code Tables, for suggested values.

(Definition from PID.6 in Ch. 3)

Definition: This field contains the family name under which the mother was born (i.e., before marriage). It is used to distinguish between patients with the same last name.

(Definition from NK1.26 in Ch. 3)

Definition: This field indicates the maiden name of the next of kin/associated party's mother.

(Definition from GT1.42 in Ch. 6)

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

(Definition from IN2.40 in Ch. 6)

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

(Definition from PID.28 in Ch. 3)

Attention: The PID-28 field was retained for backward compatibility only as of v 2.4 and was withdrawn and removed from this message structure as of v 2.7. It is recommended to refer to PID-10 - Race, PID-22 - Ethnic group and PID-26 - Citizenship.

(Definition from NK1.27 in Ch. 3)

Definition: This field identifies the nation or national group to which the next of kin/associated party belongs. This information may be different than the person's citizenship in countries in which multiple nationalities are recognized (e.g., Spain: Basque, Catalan, etc.). Refer to User-defined Table 0212 - Nationality in Chapter 2C, Code Tables, for suggested values.

(Definition from GT1.43 in Ch. 6)

Definition: This field contains a code that identifies the nation or national grouping to which the person belongs. This 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 suggested values in User-defined Table 0212 - Nationality in Chapter 2C, Code Tables.

(Definition from IN2.41 in Ch. 6)

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.

(Definition from PID.22 in Ch. 3)

Definition: This field further defines the patient's ancestry. Refer to User-defined Table 0189 - Ethnic Group in Chapter 2C, Code Tables, for suggested values. The second triplet of the CWE 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.

(Definition from NK1.28 in Ch. 3)

Definition: This field contains the next of kin/associated party's ethnic group. Refer to User-defined Table 0189 - Ethnic Group in Chapter 2C, Code Tables, for suggested values. The second triplet of the CWE 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.

(Definition from GT1.44 in Ch. 6)

Definition: This field contains the guarantor'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.

(Definition from IN2.42 in Ch. 6)

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.

(Definition from STF.28 in Ch. 15)

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

(Definition from PID.16 in Ch. 3)

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

(Definition from NK1.14 in Ch. 3)

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

(Definition from IN2.43 in Ch. 6)

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.

(Definition from STF.17 in Ch. 15)

Definition: This field contains the staff member's marital status. Refer to User-defined Table 0002 - Marital Status in Chapter 2C, Code Tables, for suggested values. Same values as those for PID-16 Marital Status.

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

(Definition from GT1.32 in Ch. 6)

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

(Definition from IN2.45 in Ch. 6)

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

(Definition from GT1.49 in Ch. 6)

Definition: This field contains a descriptive name of the guarantor's occupation (e.g., Sr. Systems Analyst, Sr. Accountant).

(Definition from IN2.46 in Ch. 6)

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

(Definition from STF.18 in Ch. 15)

Definition: This field contains a descriptive name of the staff member's occupation (e.g., Sr. Systems Analyst, Sr. Accountant).

(Definition from GT1.50 in Ch. 6)

Definition: This field contains the guarantor's job code and employee classification.

(Definition from IN2.47 in Ch. 6)

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

(Definition from STF.19 in Ch. 15)

Definition: This field contains the staff member's job code and employee classification. Refer to User-defined Table 0327 - Job Code and User-defined Table 0328 - Employee Classification in Chapter 2C, Code Tables, for suggested values.

(Definition from NK1.34 in Ch. 3)

Definition: This field identifies the next of kin/associated party's job status. Refer to User-defined Table 0311 - Job Status in Chapter 2C, Code Tables, for suggested values.

(Definition from GT1.53 in Ch. 6)

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

(Definition from IN2.48 in Ch. 6)

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.

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.

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.

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.

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

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.

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

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).

Definition: This field indicates the date after which the relationship (defined in IN1-17 - Insured's 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 in Chapter 2C, Code Tables, for suggested values.

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.

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.

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.

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.

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.

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.

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.

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.

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

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

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

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.

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.

(Definition from PID.10 in Ch. 3)

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

(Definition from NK1.35 in Ch. 3)

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

(Definition from IN2.71 in Ch. 6)

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.

(Definition from STF.27 in Ch. 15)

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

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.

(Definition from IN2.73 in Ch. 6)

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

(Definition from GP2.13 in Ch. 6)

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