The IN1 segment contains insurance policy coverage information necessary to produce properly pro‑rated and patient and insurance bills.
IN1 Attributes
The fields in the IN1 segment are as follows:
| SEQ | LEN | DT | OPT | RP/# | ELEMENT NAME |
|---|---|---|---|---|---|
| 1 | 4 | SI | R | Set ID – Patient ID | |
| 2 | 60 | CE | R | Insurance Plan ID | |
| 3 | 59 | CX | R | Y | Insurance Company ID |
| 4 | 130 | XON | O | Y | Insurance Company Name |
| 5 | 106 | XAD | O | Y | Insurance Company Address |
| 6 | 48 | XPN | O | Y | Insurance Co Contact Person |
| 7 | 40 | XTN | O | Y | Insurance Co Phone Number |
| 8 | 12 | ST | O | Group Number | |
| 9 | 130 | XON | O | Y | Group Name |
| 10 | 12 | CX | O | Y | Insured’s Group Emp ID |
| 11 | 130 | XON | O | Y | Insured’s Group Emp Name |
| 12 | 8 | DT | O | Plan Effective Date | |
| 13 | 8 | DT | O | Plan Expiration Date | |
| 14 | 55 | CM | O | Authorization Information | |
| 15 | 3 | IS | O | Plan Type | |
| 16 | 48 | XPN | O | Y | Name Of Insured |
| 17 | 80 | CE | O | Insured’s Relationship To Patient | |
| 18 | 26 | TS | O | Insured’s Date Of Birth | |
| 19 | 160 | XAD | O | Y | Insured’s Address |
| 20 | 2 | IS | O | Assignment Of Benefits | |
| 21 | 2 | IS | O | Coordination Of Benefits | |
| 22 | 2 | ST | O | Coord Of Ben. Priority | |
| 23 | 1 | ID | O | Notice Of Admission Flag | |
| 24 | 8 | DT | O | Notice Of Admission Date | |
| 25 | 1 | IS | O | Report Of Eligibility Flag | |
| 26 | 8 | DT | O | Report Of Eligibility Date | |
| 27 | 2 | IS | O | Release Information Code | |
| 28 | 15 | ST | O | Pre-Admit Cert (PAC) | |
| 29 | 26 | TS | O | Verification Date/Time | |
| 30 | 60 | XCN | O | Y | Verification By |
| 31 | 2 | IS | O | Type Of Agreement Code | |
| 32 | 2 | IS | O | Billing Status | |
| 33 | 4 | NM | O | Lifetime Reserve Days | |
| 34 | 4 | NM | O | Delay Before L.R. Day | |
| 35 | 8 | IS | O | Company Plan Code | |
| 36 | 15 | ST | O | Policy Number | |
| 37 | 12 | CP | O | Policy Deductible | |
| 38 | 12 | CP | O | Policy Limit – Amount | |
| 39 | 4 | NM | O | Policy Limit – Days | |
| 40 | 12 | CP | O | Room Rate – Semi-Private | |
| 41 | 12 | CP | O | Room Rate – Private | |
| 42 | 60 | CE | R | Insured’s Employment Status | |
| 43 | 1 | IS | R | Insured’s Sex | |
| 44 | 106 | XAD | R | Y | Insured’s Employer’s Address |
| 45 | 2 | ST | O | Verification Status | |
| 46 | 8 | IS | O | Prior Insurance Plan ID | |
| 47 | 3 | IS | O | Coverage Type | |
| 48 | 2 | IS | O | Handicap | |
| 49 | 12 | CX | O | Y | Insured’s ID Number |
*Note: For the complete HL7 Standard, please go to the HL7 organization website.
In HL7 pipe and hat format, the IN1 segment (shown in red) for an ADT-A01 message would look like this:
MSH|^~&|AcmeHIS|StJohn|ADT|StJohn|20050518073622||ADT^A01|MSGID20050518073622|P|2.3
EVN|A01
PID|||12001||Jones^John^^^Mr.||19670822|M|||123 West St.^^Denver^CO^80020^USA||(850)555-
0809|||||99345|460-99-2928
PV1||I|Main^802^1||||^Quacker^John|||IP|||||||||1|||||||||||||||||||||||||20050518073622
IN1|1|EPO|80|AETNA US HEALTHCARE|PO BOX 981114^””^EL PASO^TX^79998^””|||1500004000001|AETNA SERVICES INC|19|AETNA US
HEALTHCARE|””|””||2|SOUTAR^RENEE^D|3|19700722|13324 WHITE CEMETERY
RD^””^HANNIBAL^NY^130740000^””|||||||||||||||||124705454||||||1|F|225
GREENFIELD PARKWAY^^LIVERPOOL^NY^13088|185428
IN2|1||124705454||461-1200||||||
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