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The IN3 segment contains additional insurance information for certifying the need for patient care. Fields used by this segment are defined by CMS, or other regulatory agencies.

HL7 Attribute Table - IN3 - Insurance Additional Information, Certification Segment

Seq#	DataElement	Description	Must Implement	Flags	Cardinality	Length	C.LEN	Vocabulary	DataType
IN3
1	00502	Set ID - IN3	SHALL		[1..1]	[1..4]			SI
2	00503	Certification Number			[0..1]				CX
3	00504	Certified By			[0..*]				XCN
4	00505	Certification Required			[0..1]	[1..1]		0136 Yes/no Indicator	ID
5	00506	Penalty			[0..1]				MOP
6	00507	Certification Date/Time			[0..1]				DTM
7	00508	Certification Modify Date/Time			[0..1]				DTM
8	00509	Operator			[0..*]				XCN
9	00510	Certification Begin Date			[0..1]				DT
10	00511	Certification End Date			[0..1]				DT
11	00512	Days			[0..1]				DTN
12	00513	Non-Concur Code/Description			[0..1]			0233	CWE
13	00514	Non-Concur Effective Date/Time			[0..1]				DTM
14	00515	Physician Reviewer			[0..*]			0010	XCN
15	00516	Certification Contact		#	[0..1]		48		ST
16	00517	Certification Contact Phone Number			[0..*]				XTN
17	00518	Appeal Reason			[0..1]			0345	CWE
18	00519	Certification Agency			[0..1]			0346	CWE
19	00520	Certification Agency Phone Number			[0..*]				XTN
20	00521	Pre-Certification Requirement			[0..*]			0136 Yes/no Indicator	ICD
21	00522	Case Manager		#	[0..1]		48		ST
22	00523	Second Opinion Date			[0..1]				DT
23	00524	Second Opinion Status			[0..1]			0151	CWE
24	00525	Second Opinion Documentation Received			[0..*]			0152	CWE
25	00526	Second Opinion Physician			[0..*]			0010	XCN
26	03336	Certification Type			[0..1]			0921 Certification Type Code	CWE
27	03337	Certification Category			[0..1]			0922 Certification Category Code	CWE
28	02483	Online Verification Date/Time			[0..1]				DTM
29	02484	Online Verification Result	MAY True: False:	C(R/X)	[1..1] [0..1]			0970	CWE
30	02485	Online Verification Result Error Code	MAY True: False:	C(RE/X)	[1..1] [0..1]			0971	CWE
31	02486	Online Verification Result Check Digit	MAY True: False:	C(R/X)	[1..1] [0..1]				ST

Definition: IN3-1 - Set ID - IN3 contains the number that identifies this transaction. For the first occurrence of the segment the sequence number shall be 1, for the second occurrence it shall be 2, etc. The set ID in the IN3 segment is used when there are multiple certifications for the insurance plan identified in IN1-2.

Definition: This field contains the number assigned by the certification agency. The assigning authority and identifier type code are strongly recommended for all CX data types.

Definition: This field contains the party that approved the certification. Multiple names and identifiers for the same person may be sent in this sequence Specification of meaning based on sequence is deprecated.

Definition: This field indicates whether certification is required. Refer to HL7 Table 0136 - Yes/no Indicator in Chapter 2C, Code Tables, for valid values.

• Y    certification required

• N    certification not required

Definition: This field contains the penalty, in dollars or a percentage that will be assessed if the pre-certification is not performed.

Definition: This field contains the date and time stamp that indicates when insurance was certified to exist for the patient.

Definition: This field contains the date/time that the certification was modified.

Definition: This field contains the name party who is responsible for sending this certification information. Multiple names for the same person may be sent in this sequence. Specification of meaning based on sequence is deprecated.

Definition: This field contains the date that this certification begins.

Definition: This field contains date that this certification ends.

Definition: This field contains the number of days for which this certification is valid. This field applies to denied, pending, or approved days.

Definition: This field contains the non-concur code and description for a denied request. Refer to User-defined Table 0233 - Non-Concur Code/Description in Chapter 2C, Code Tables, for suggested values.

Definition: This field contains the effective date of the non-concurrence classification.

Definition: This field contains the physician who works with and reviews cases that are pending physician review for the certification agency. Multiple names for the same person may be sent in this sequence. Specification of meaning based on sequence is deprecated. Refer to User-defined Table 0010 - Physician ID in Chapter 2C, Code Tables, for suggested values.

Definition: This field contains the name of the party contacted at the certification agency who granted the certification and communicated the certification number.

Definition: This field contains the phone number of the certification contact. Multiple phone numbers for the same certification contact may be sent in this sequence. 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 that an appeal was made on a non-concur for certification. Refer to User-defined Table 0345 - Appeal Reason in Chapter 2C, Code Tables, for suggested values.

Definition: This field contains the certification agency. Refer to User-defined Table 0346 - Certification Agency in Chapter 2C, Code Tables, for suggested values.

Definition: This field contains the phone number of the certification agency.

Definition: This field indicates whether pre-certification is required for particular patient types, and the time window for obtaining the certification. The following components of this field are defined as follows:

• pre-certification required refers to HL7 Table 0136 - Yes/no Indicator in Chapter 2C, Code Tables, for valid values.

• Y    pre-certification required

• N    no pre-certification required

• pre-certification window is the date/time by which the pre-certification must be obtained.

Definition: This field contains the name of the entity, which is handling this particular patient's case (e.g., UR nurse, or a specific healthcare facility location).

Definition: This field contains the date that the second opinion was obtained.

Definition: This field contains the code that represents the status of the second opinion. Refer to User-defined Table 0151 - Second Opinion Status in Chapter 2C, Code Tables, for suggested values.

Definition: Use this field if accompanying documentation has been received by the provider. Refer to User-defined Table 0152 - Second Opinion Documentation Receivedin Chapter 2C, Code Tables,for suggested values.

Definition: This field contains an identifier and name of the physician who provided the second opinion. Multiple names and identifiers for the same person may be sent in this sequence. Specification of meaning based on sequence is deprecated. Refer to User-defined Table 0010 - Physician ID in Chapter 2C, Code Tables, for suggested values.

Definition: This field contains the certification type code for a specific certification. Refer to User-defined Table 0921 – Certification Type Code in Chapter 2C, Code Tables, for suggested values.

Definition: This field contains the certification category code for a specific certification. Refer to User-defined Table 0922 – Certification Category Code in Chapter 2C, Code Tables, for suggested values.

Definition: This field contains the timestamp of the online verification of the insurance information.

Definition: This field contains the result of the online verification. Refer to User-defined Table 0970 – Online Verification Result in Chapter 2C, Code Tables, for suggested values. This field is required if IN3-28 is populated.

Definition: This field contains the error code for the result of the online verification. Refer to User-defined Table 0791 – Online Verification Result Error Code in Chapter 2C, Code Tables, for suggested values. This field is required if IN3-28 is populated and an error status is returned.

Definition: This field contains the check digit for the online verification of the insurance information. This field is required if IN3-28 is populated.