Class steward is Patient Administration
Defines a collection of health benefits, specified as coverage items, that can be purchased as a single package or product from an insurer.
Description of the access protocol for designated services, for example, prior to elective surgery call (999) 999-9999.
A code serving as an additional refinement of an insurance plan. (e.g., standard, unified, maternity, . . .).
|IN1^31^00456^Type of Agreement Code|
An indication as to whether the insured agreed to assign the insurance benefits to the healthcare provider.
ExtRef: This information is reported on UB92 FL 53.
|IN1^20^00445^Assignment of Benefits|
A description of the healthcare benefit. For example, Healthpol-Plus is a health insurance offering of xyz company that offers additional vison and dental benefits over the standard Healthpol product.
Rationale: Clarify attribute name and definition.
OpenIssue: PAFM needs to continue to work on this definition since it is still to fuzzy. Need additional explicit examples. Committee will continue to work on definition and consult with Information Management.
The name of the benefit product.
|FT1^14^00368^Insurance Plan ID| |IN1^2^00368^Insurance Plan ID|
A code classifying the benefit product type (e.g., commercial, Medicare, Medicaid, . . .).
|DRG^8^00770^DRG Payor| |IN1^15^00440^Plan Type|
An indication as to whether this insurance product ever works in conjunction with other insurance plans or not. If it does not, it provides independent coverage and payment of benefits regardless of other insurance that might be available to the patient. For example, a cancer policy pays which pays a per diem rate regardless of other coverage is considered independent coverage. This attribute does not indicate the priorty order for coordination of benefits, or whether a patient is covered by multiple plans.
Rationale: This element is an IS datatype in 2.3 with suggested values of CO- Coodinated, IN - Independent.
|IN1^21^00446^Coordination of Benefits|
The priority sequence for an insurance plan that works in conjunction with other insurance.
|IN1^22^00447^Coord of Ben. Priority|
An indication as to whether charges for a baby should be combined with charges for the mother.
|IN2^20^00491^Combine Baby Bill|
A code indicating the type of coverage (e.g. hospital/institutional, physician/professional, both hospital and physician.)
|IN1^47^01227^Coverage Type| |LRL^4^01227^Coverage Type|
The range of dates during which the healthcare coverage is effective. These dates represent the effective dates for the product, not the effective dates of coverage for a covered individual.
|IN1^12^00437^Plan Effective Date| |IN1^13^00438^Plan Expiration Date|
A indication as to whether the healthcare coverage is a group contract.
The unique identifier for the healthcare coverage benefit product.
Rationale: Duplicate of Healthcare_benefit_plan.benefit_plan_ID
OpenIssue: For CQ to resolve: we must have a data type for this that covers the instance identifier, the identifier type, and the assigning authority ID. This is a repeatable attribute.
|IN1^35^00460^Company Plan Code| |IN1^46^00471^Prior Insurance Plan ID|
A code indicating the party to which the claim should be mailed (e.g., employer, guarantor, insurance company, patient, . . .).
|IN2^5^00476^Mail Claim Party|
The policy category code (e.g., ANC-ancillary, MMD-major medical)
|IN2^29^00500^Policy Type/Amount|
A code describing what information, if any, a provider can release about a patient.
OpenIssue: Need example codes or codes set.
ExtRef: This information is reported on UB92 FL 52.
|IN1^27^00452^Release Information Code|
A code depicting the status of the healthcare product.
OpenIssue: The x-ref 00487^Champus Status needs to be moved to a different class, currently under consideration. In 2.x, this referred to UB82 codes indicative active, deceased, or retired for claims.
|IN2^16^00487^Champus Status|
OpenIssue: Is the fully optional many-to-many on both ends correct?