IN1 Segment

Set ID - IN1

Insurance Plan ID

Insurance Company ID

Insurance Company Name

Insurance Company Address

Insurance Co Contact Person

Insurance Co Phone Number

Group Number

Group Name

Insured’s Group Emp ID

Insured’s Group Emp Name

Plan Effective Date

Plan Expiration Date

Authorization Information

Plan Type

Name of Insured

Insured’s Relationship to Patient

Insured’s Date of Birth

Insured’s Address

Assignment of Benefits

Coordination of Benefits

Coord Of Ben. Priority

Notice of Admission Flag

Notice of Admission Date

Report of Eligibility Flag

Report of Eligibility Date

Release Information Code

Pre-Admit Cert (PAC)

Verification Date/Time

Verification By

Type of Agreement Code

Billing Status

Lifetime Reserve Days

Delay Before L.R. Day

Company Plan Code

Policy Number

Policy Deductible

Policy Limit - Amount

Policy Limit - Days

Room Rate - Semi-Private

Room Rate - Private

Insured’s Employment Status

Insured’s Administrative Sex

Insured’s Employer’s Address

Verification Status

Prior Insurance Plan ID

Coverage Type

Handicap

Insured’s ID Number

Signature Code

Signature Code Date

Insured’s Birth Place

VIP Indicator

External Health Plan Identifiers