IN3 segment

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. SEQ LEN DT OPT RP/# TBL# ITEM# ELEMENT NAME 1 4 SI R 00502 Set ID - IN3 2 250 CX O 00503 Certification Number 3 250 XCN O Y 00504 Certified By

The shape of one line

required optional

Count the pipes to find a field, and count the empty ones too: an empty field still holds its place. Leave out the separator before IN3-3 and its value arrives as IN3-2, so the receiver stores Certified By as Certification Number.

This page carries the IN3 field table as published and nothing beyond it. The field notes, vendor behaviour, FHIR mapping and parsing guidance that thePID page has are still to be written for IN3.

Every field

SEQ LEN DT OPT RP/# TBL# ITEM# Element name Cardinality

IN3-1 4 SI R 00502 Set ID - IN3 1..1

IN3-2 250 CX O 00503 Certification Number 0..1

IN3-2 is a CX, which holds 10 components separated by carets.

SEQ	LEN	DT	OPT	TBL#	Component name
CX.1	15	ST	R		ID Number
CX.2	1	ST	O		Check Digit
CX.3	3	ID	O	0061	Check Digit Scheme
CX.4	227	HD	O	0363	Assigning Authority
CX.5	5	ID	O	0203	Identifier Type Code
CX.6	227	HD	O		Assigning Facility
CX.7	8	DT	O		Effective Date
CX.8	8	DT	O		Expiration Date
CX.9	705	CWE	O		Assigning Jurisdiction
CX.10	705	CWE	O		Assigning Agency or Department

IN3-3 250 XCN O Y 00504 Certified By 0..*

IN3-3 is a XCN, which holds 23 components separated by carets.

SEQ	LEN	DT	OPT	TBL#	Component name
XCN.1	15	ST	O		ID Number
XCN.2	194	FN	O		Family Name
XCN.3	30	ST	O		Given Name
XCN.4	30	ST	O		Second and Further Given Names or Initials Thereof
XCN.5	20	ST	O		Suffix (e.g., JR or III)
XCN.6	20	ST	O		Prefix (e.g., DR)
XCN.7	5	IS	B	0360	Degree (e.g., MD)
XCN.8	4	IS	C	0297	Source Table
XCN.9	227	HD	O	0363	Assigning Authority
XCN.10	1	ID	O	0200	Name Type Code
XCN.11	1	ST	O		Identifier Check Digit
XCN.12	3	ID	C	0061	Check Digit Scheme
XCN.13	5	ID	O	0203	Identifier Type Code
XCN.14	227	HD	O		Assigning Facility
XCN.15	1	ID	O	0465	Name Representation Code
XCN.16	483	CE	O	0448	Name Context
XCN.17	53	DR	B		Name Validity Range
XCN.18	1	ID	O	0444	Name Assembly Order
XCN.19	26	TS	O		Effective Date
XCN.20	26	TS	O		Expiration Date
XCN.21	199	ST	O		Professional Suffix
XCN.22	705	CWE	O		Assigning Jurisdiction
XCN.23	705	CWE	O		Assigning Agency or Department

IN3-4 1 ID O 0136 00505 Certification Required 0..1

IN3-5 23 MOP O 00506 Penalty 0..1

IN3-5 is a MOP, which holds 3 components separated by carets.

SEQ	LEN	DT	OPT	TBL#	Component name
MOP.1	2	ID	R	0148	Money or Percentage Indicator
MOP.2	16	NM	R		Money or Percentage Quantity
MOP.3	3	ID	O		Currency Denomination

IN3-6 26 TS O 00507 Certification Date/Time 0..1

IN3-6 is a TS, which holds 2 components separated by carets.

SEQ	LEN	DT	OPT	TBL#	Component name
TS.1	24	DTM	R		Time
TS.2	1	ID	B	0529	Degree of Precision

IN3-7 26 TS O 00508 Certification Modify Date/Time 0..1

IN3-7 is a TS, which holds 2 components separated by carets.

SEQ	LEN	DT	OPT	TBL#	Component name
TS.1	24	DTM	R		Time
TS.2	1	ID	B	0529	Degree of Precision

IN3-8 250 XCN O Y 00509 Operator 0..*

IN3-8 is a XCN, which holds 23 components separated by carets.

SEQ	LEN	DT	OPT	TBL#	Component name
XCN.1	15	ST	O		ID Number
XCN.2	194	FN	O		Family Name
XCN.3	30	ST	O		Given Name
XCN.4	30	ST	O		Second and Further Given Names or Initials Thereof
XCN.5	20	ST	O		Suffix (e.g., JR or III)
XCN.6	20	ST	O		Prefix (e.g., DR)
XCN.7	5	IS	B	0360	Degree (e.g., MD)
XCN.8	4	IS	C	0297	Source Table
XCN.9	227	HD	O	0363	Assigning Authority
XCN.10	1	ID	O	0200	Name Type Code
XCN.11	1	ST	O		Identifier Check Digit
XCN.12	3	ID	C	0061	Check Digit Scheme
XCN.13	5	ID	O	0203	Identifier Type Code
XCN.14	227	HD	O		Assigning Facility
XCN.15	1	ID	O	0465	Name Representation Code
XCN.16	483	CE	O	0448	Name Context
XCN.17	53	DR	B		Name Validity Range
XCN.18	1	ID	O	0444	Name Assembly Order
XCN.19	26	TS	O		Effective Date
XCN.20	26	TS	O		Expiration Date
XCN.21	199	ST	O		Professional Suffix
XCN.22	705	CWE	O		Assigning Jurisdiction
XCN.23	705	CWE	O		Assigning Agency or Department

IN3-9 8 DT O 00510 Certification Begin Date 0..1

IN3-10 8 DT O 00511 Certification End Date 0..1

IN3-11 6 DTN O 00512 Days 0..1

IN3-11 is a DTN, which holds 2 components separated by carets.

SEQ	LEN	DT	OPT	TBL#	Component name
DTN.1	2	IS	R	0149	Day Type
DTN.2	3	NM	R		Number of Days

IN3-12 250 CE O 0233 00513 Non-Concur Code/Description 0..1

IN3-12 is a CE, which holds 6 components separated by carets.

SEQ	LEN	DT	OPT	TBL#	Component name
CE.1	20	ST	O		Identifier
CE.2	199	ST	O		Text
CE.3	20	ID	O	0396	Name of Coding System
CE.4	20	ST	O		Alternate Identifier
CE.5	199	ST	O		Alternate Text
CE.6	20	ID	O	0396	Name of Alternate Coding System

IN3-13 26 TS O 00514 Non-Concur Effective Date/Time 0..1

IN3-13 is a TS, which holds 2 components separated by carets.

SEQ	LEN	DT	OPT	TBL#	Component name
TS.1	24	DTM	R		Time
TS.2	1	ID	B	0529	Degree of Precision

IN3-14 250 XCN O Y 0010 00515 Physician Reviewer 0..*

IN3-14 is a XCN, which holds 23 components separated by carets.

SEQ	LEN	DT	OPT	TBL#	Component name
XCN.1	15	ST	O		ID Number
XCN.2	194	FN	O		Family Name
XCN.3	30	ST	O		Given Name
XCN.4	30	ST	O		Second and Further Given Names or Initials Thereof
XCN.5	20	ST	O		Suffix (e.g., JR or III)
XCN.6	20	ST	O		Prefix (e.g., DR)
XCN.7	5	IS	B	0360	Degree (e.g., MD)
XCN.8	4	IS	C	0297	Source Table
XCN.9	227	HD	O	0363	Assigning Authority
XCN.10	1	ID	O	0200	Name Type Code
XCN.11	1	ST	O		Identifier Check Digit
XCN.12	3	ID	C	0061	Check Digit Scheme
XCN.13	5	ID	O	0203	Identifier Type Code
XCN.14	227	HD	O		Assigning Facility
XCN.15	1	ID	O	0465	Name Representation Code
XCN.16	483	CE	O	0448	Name Context
XCN.17	53	DR	B		Name Validity Range
XCN.18	1	ID	O	0444	Name Assembly Order
XCN.19	26	TS	O		Effective Date
XCN.20	26	TS	O		Expiration Date
XCN.21	199	ST	O		Professional Suffix
XCN.22	705	CWE	O		Assigning Jurisdiction
XCN.23	705	CWE	O		Assigning Agency or Department

IN3-15 48 ST O 00516 Certification Contact 0..1

IN3-16 250 XTN O Y 00517 Certification Contact Phone Number 0..*

IN3-16 is a XTN, which holds 12 components separated by carets.

SEQ	LEN	DT	OPT	TBL#	Component name
XTN.1	199	ST	B		Telephone Number
XTN.2	3	ID	O	0201	Telecommunication Use Code
XTN.3	8	ID	O	0202	Telecommunication Equipment Type
XTN.4	199	ST	O		Email Address
XTN.5	3	NM	O		Country Code
XTN.6	5	NM	O		Area/City Code
XTN.7	9	NM	O		Local Number
XTN.8	5	NM	O		Extension
XTN.9	199	ST	O		Any Text
XTN.10	4	ST	O		Extension Prefix
XTN.11	6	ST	O		Speed Dial Code
XTN.12	199	ST	C		Unformatted Telephone number

IN3-17 250 CE O 0345 00518 Appeal Reason 0..1

IN3-17 is a CE, which holds 6 components separated by carets.

SEQ	LEN	DT	OPT	TBL#	Component name
CE.1	20	ST	O		Identifier
CE.2	199	ST	O		Text
CE.3	20	ID	O	0396	Name of Coding System
CE.4	20	ST	O		Alternate Identifier
CE.5	199	ST	O		Alternate Text
CE.6	20	ID	O	0396	Name of Alternate Coding System

IN3-18 250 CE O 0346 00519 Certification Agency 0..1

IN3-18 is a CE, which holds 6 components separated by carets.

SEQ	LEN	DT	OPT	TBL#	Component name
CE.1	20	ST	O		Identifier
CE.2	199	ST	O		Text
CE.3	20	ID	O	0396	Name of Coding System
CE.4	20	ST	O		Alternate Identifier
CE.5	199	ST	O		Alternate Text
CE.6	20	ID	O	0396	Name of Alternate Coding System

IN3-19 250 XTN O Y 00520 Certification Agency Phone Number 0..*

IN3-19 is a XTN, which holds 12 components separated by carets.

SEQ	LEN	DT	OPT	TBL#	Component name
XTN.1	199	ST	B		Telephone Number
XTN.2	3	ID	O	0201	Telecommunication Use Code
XTN.3	8	ID	O	0202	Telecommunication Equipment Type
XTN.4	199	ST	O		Email Address
XTN.5	3	NM	O		Country Code
XTN.6	5	NM	O		Area/City Code
XTN.7	9	NM	O		Local Number
XTN.8	5	NM	O		Extension
XTN.9	199	ST	O		Any Text
XTN.10	4	ST	O		Extension Prefix
XTN.11	6	ST	O		Speed Dial Code
XTN.12	199	ST	C		Unformatted Telephone number

IN3-20 40 ICD O Y 00521 Pre-Certification Requirement 0..*

IN3-20 is a ICD, which holds 3 components separated by carets.

SEQ	LEN	DT	OPT	TBL#	Component name
ICD.1	11	IS	O	0150	Certification Patient Type
ICD.2	1	ID	R	0136	Certification Required
ICD.3	26	TS	O		Date/Time Certification Required

IN3-21 48 ST O 00522 Case Manager 0..1

IN3-22 8 DT O 00523 Second Opinion Date 0..1

IN3-23 1 IS O 0151 00524 Second Opinion Status 0..1

IN3-24 1 IS O Y 0152 00525 Second Opinion Documentation Received 0..*

IN3-25 250 XCN O Y 0010 00526 Second Opinion Physician 0..*

IN3-25 is a XCN, which holds 23 components separated by carets.

SEQ	LEN	DT	OPT	TBL#	Component name
XCN.1	15	ST	O		ID Number
XCN.2	194	FN	O		Family Name
XCN.3	30	ST	O		Given Name
XCN.4	30	ST	O		Second and Further Given Names or Initials Thereof
XCN.5	20	ST	O		Suffix (e.g., JR or III)
XCN.6	20	ST	O		Prefix (e.g., DR)
XCN.7	5	IS	B	0360	Degree (e.g., MD)
XCN.8	4	IS	C	0297	Source Table
XCN.9	227	HD	O	0363	Assigning Authority
XCN.10	1	ID	O	0200	Name Type Code
XCN.11	1	ST	O		Identifier Check Digit
XCN.12	3	ID	C	0061	Check Digit Scheme
XCN.13	5	ID	O	0203	Identifier Type Code
XCN.14	227	HD	O		Assigning Facility
XCN.15	1	ID	O	0465	Name Representation Code
XCN.16	483	CE	O	0448	Name Context
XCN.17	53	DR	B		Name Validity Range
XCN.18	1	ID	O	0444	Name Assembly Order
XCN.19	26	TS	O		Effective Date
XCN.20	26	TS	O		Expiration Date
XCN.21	199	ST	O		Professional Suffix
XCN.22	705	CWE	O		Assigning Jurisdiction
XCN.23	705	CWE	O		Assigning Agency or Department

Message types carrying IN3

IN3 appears in 30 message structures, belonging to 21 message types.

IN3 segment

The shape of one line

Every field

Related

Message types carrying IN3