HL7 - Version 2.9.1


Segment IN3: Insurance Additional Information, Certification (Versicherungsinformationen - Kostenübernahme)

Seq Description German Interpretation Length C.LEN Table r/o/c Rep# Item Data Structure Section
1 Set ID - IN3 IN3-Segmentnummer 1..4

R
00502 SI 6.5.8.1
2 Certification Number



O
00503 CX 6.5.8.2
3 Certified By



O Y 00504 XCN 6.5.8.3
4 Certification Required
1..1
0136 O
00505 ID 6.5.8.4
5 Penalty



O
00506 MOP 6.5.8.5
6 Certification Date/Time



O
00507 DTM 6.5.8.6
7 Certification Modify Date/Time



O
00508 DTM 6.5.8.7
8 Operator



O Y 00509 XCN 6.5.8.8
9 Certification Begin Date



O
00510 DT 6.5.8.9
10 Certification End Date



O
00511 DT 6.5.8.10
11 Days



O
00512 DTN 6.5.8.11
12 Non-Concur Code/Description


0233 O
00513 CWE 6.5.8.12
13 Non-Concur Effective Date/Time



O
00514 DTM 6.5.8.13
14 Physician Reviewer


0010 O Y 00515 XCN 6.5.8.14
15 Certification Contact

48#
O
00516 ST 6.5.8.15
16 Certification Contact Phone Number



O Y 00517 XTN 6.5.8.16
17 Appeal Reason


0345 O
00518 CWE 6.5.8.17
18 Certification Agency


0346 O
00519 CWE 6.5.8.18
19 Certification Agency Phone Number



O Y 00520 XTN 6.5.8.19
20 Pre-Certification Requirement


0136 O Y 00521 ICD 6.5.8.20
21 Case Manager

48#
O
00522 ST 6.5.8.21
22 Second Opinion Date



O
00523 DT 6.5.8.22
23 Second Opinion Status


0151 O
00524 CWE 6.5.8.23
24 Second Opinion Documentation Received


0152 O Y 00525 CWE 6.5.8.24
25 Second Opinion Physician


0010 O Y 00526 XCN 6.5.8.25
26 Certification Type


0921 O
03336 CWE 6.5.8.26
27 Certification Category


0922 O
03337 CWE 6.5.8.27
28 Online Verification Date/Time



O N 02483 DTM 6.5.8.28
29 Online Verification Result


0970 C(R/X) N 02484 CWE 6.5.8.29
30 Online Verification Result Error Code


0971 C(RE/X) N 02485 CWE 6.5.8.30
31 Online Verification Result Check Digit



C(R/X) N 02486 ST 6.5.8.31

Used within following Message Structures:

ADT_A01 (3.3.1)
ADT_A03 (3.3.3)
ADT_A05 (3.3.5)
ADT_A06 (3.3.6)
ADT_A16 (3.3.16)
BAR_P01 (6.4.1)
BAR_P05 (6.4.5)
DFT_P03 (6.4.3)
DFT_P11 (6.4.8)
DFT_P11 (6.4.8)
OMB_O27 (4.13.2)
OMD_O03 (4.7.1)
OMG_O19 (4.4.4)
OMI_O23 (4.4.14)
OML_O21 (4.4.6)
OML_O33 (4.4.8)
OML_O35 (4.4.10)
OML_O39 (4.4.12)
OML_O59 (4.4.22)
OMN_O07 (4.10.3)
OMP_O09 (4A.3.3)
OMQ_O57 (4.4.20)
OMS_O05 (4.10.1)
OPL_O37 (4.4.16)
ORU_R01 (7.3.1)
RDE_O11 (4A.3.6)
RDE_O49 (4A.3.24)
REF_I12 (11.5.1)
RPA_I08 (11.4.1)
RPI_I01 (11.3.1)
RPI_I04 (11.3.4)
RQA_I08 (11.4.1)
RQI_I01 (11.3.1)
VXU_V04 (4A.7.6)