IN1 — Insurance

Appears in ADT and DFT messages. Typically follows GT1. Multiple IN1 segments for multiple insurance plans.

The IN1 segment carries the primary insurance plan information for a patient encounter, including the insurance company, policy details, group information, and coverage dates. Multiple IN1 segments accommodate primary, secondary, and tertiary insurance.

Real-World Context

IN1 is where insurance billing lives. The three-way combination of IN1.3 (insurance company ID), IN1.8 (group number), and IN1.36 (policy number) must match what the payer has on file or every claim will be denied. Subscriber relationship in IN1.17 is checked against the patient's relationship to the subscriber. Getting these fields wrong is the primary cause of eligibility verification failures and claim denials.

Field Reference

Click any row to see the full description, common values, and troubleshooting tip.

#	Field Name	Type	Req	Max Len
1	Set ID - IN1	SI	R	4	▶
2	Insurance Plan ID	CE	R	250	▶
3	Insurance Company ID	CX	R	250	▶
4	Insurance Company Name	XON	O	250	▶
5	Insurance Company Address	XAD	O	250	▶
6	Insurance Co Contact Person	XPN	O	250	▶
7	Insurance Co Phone Number	XTN	O	250	▶
8	Group Number	ST	O	12	▶
9	Group Name	XON	O	250	▶
10	Insured's Group Emp ID	CX	O	250	▶
11	Insured's Group Emp Name	XON	O	250	▶
12	Plan Effective Date	DT	O	8	▶
13	Plan Expiration Date	DT	O	8	▶
14	Authorization Information	AUI	O	239	▶
15	Plan Type	IS	O	3	▶
16	Name of Insured	XPN	O	250	▶
17	Insured's Relationship to Patient	CE	O	250	▶
18	Insured's Date of Birth	TS	O	26	▶
19	Insured's Address	XAD	O	250	▶
20	Assignment of Benefits	IS	O	2	▶
21	Coordination of Benefits	IS	O	2	▶
22	Coord of Ben. Priority	ST	O	2	▶
23	Notice of Admission Flag	ID	O	1	▶
24	Notice of Admission Date	DT	O	8	▶
25	Report of Eligibility Flag	ID	O	1	▶
26	Report of Eligibility Date	DT	O	8	▶
27	Release Information Code	IS	O	2	▶
28	Pre-Admit Cert (PAC)	ST	O	15	▶
29	Verification Date/Time	TS	O	26	▶
30	Verification By	XCN	O	250	▶
31	Type of Agreement Code	IS	O	2	▶
32	Billing Status	IS	O	2	▶
33	Lifetime Reserve Days	NM	O	4	▶
34	Delay Before L.R. Day	NM	O	4	▶
35	Company Plan Code	IS	O	8	▶
36	Policy Number	ST	O	15	▶
37	Policy Deductible	CP	O	12	▶
38	Policy Limit - Amount	CP	O	12	▶
39	Policy Limit - Days	NM	O	4	▶
40	Room Rate - Semi-Private	CP	O	12	▶
41	Room Rate - Private	CP	O	12	▶
42	Insured's Employment Status	CE	O	250	▶
43	Insured's Administrative Sex	IS	O	1	▶
44	Insured's Employer's Address	XAD	O	250	▶
45	Verification Status	ST	O	2	▶
46	Prior Insurance Plan ID	IS	O	8	▶
47	Coverage Type	IS	O	3	▶
48	Handicap	IS	O	2	▶
49	Insured's ID Number	CX	O	250	▶

Example Segment

HL7 v2.x Message

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1IN1||1|BCBS_PPO^BCBS PPO Gold^LOCAL|00050^^^PAYER^PI|Blue Cross Blue Shield^^^BCBS|||(312)555-0100|GRP123456|ACME_CORP^^^|||20260101|20261231||PPO|DOE^JOHN^A|01^Self|19601225|123 Main St^^Springfield^IL^62701|Y||1|Y|20260310|Y|20260310||AUTH12345||20260310143205||Y||SA||60|||GOLD_PPO||1500.00&USD|1000000.00&USD|365|||||M|500 Business Pkwy^^Chicago^IL^60601|V|||B|||W123456789^^^BCBS^SN

Related Segments

Used In Message Types

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