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IN2: Insurance additional info

SEQLENGTHDTOPTRPT / #TBL #NAME
IN2.159CXO1Insured's Employee ID
IN2.211STO1Insured's Social Security Number
IN2.3130XCNO1Insured's Employer Name
IN2.41ISO10139Employer Information Data
IN2.51ISO10137Mail Claim Party
IN2.615STO1Medicare Health Ins Card Number
IN2.748XPNO1Medicaid Case Name
IN2.815STO1Medicaid Case Number
IN2.948XPNO1Champus Sponsor Name
IN2.1020STO1Champus ID Number
IN2.1180CEO1Dependent of Champus Recipient
IN2.1225STO1Champus Organization
IN2.1325STO1Champus Station
IN2.1414ISO10140Champus Service
IN2.152ISO10141Champus Rank/Grade
IN2.163ISO10142Champus Status
IN2.178DTO1Champus Retire Date
IN2.181IDO10136Champus Non-Avail Cert on File
IN2.191IDO10136Baby Coverage
IN2.201IDO10136Combine Baby Bill
IN2.211STO1Blood Deductible
IN2.2248XPNO1Special Coverage Approval Name
IN2.2330STO1Special Coverage Approval Title
IN2.248STO*Non-Covered Insurance Code
IN2.2559CXO1Payor ID
IN2.2659CXO1Payor Subscriber ID
IN2.271ISO10144Eligibility Source
IN2.2825CM_RMCO*Room Coverage Type/Amount
IN2.2925CM_PTAO*Policy Type/Amount
IN2.3025CM_DDIO1Daily Deductible
IN2.312ISO10223Living Dependency
IN2.322ISO10009Ambulatory Status
IN2.334ISO10171Citizenship
IN2.3460CEO1Primary Language
IN2.352ISO10220Living Arrangement
IN2.361CEO1Publicity Indicator
IN2.371IDO10136Protection Indicator
IN2.382ISO10231Student Indicator
IN2.393ISO10006Religion
IN2.4048XPNO1Mother s Maiden Name
IN2.4180CEO1Nationality Code
IN2.421ISO10189Ethnic Group
IN2.431ISO*0002Marital Status
IN2.448DTO1Employment Start Date
IN2.458DTO1Employment Stop Date
IN2.4620STO1Job Title
IN2.4720JCCO1Job Code/Class
IN2.482ISO10311Job Status
IN2.4948XPNO*Employer Contact Person Name
IN2.5040XTNO*Employer Contact Person Phone Number
IN2.512ISO10222Employer Contact Reason
IN2.5248XPNO*Insured s Contact Person s Name
IN2.5340XTNO*Insured s Contact Person Telephone Number
IN2.542ISO*0222Insured s Contact Person Reason
IN2.558DTO1Relationship To The Patient Start Date
IN2.568DTO*Relationship To The Patient Stop Date
IN2.572ISO10232Insurance Co. Contact Reason
IN2.5840XTNO1Insurance Co. Contact Phone Number
IN2.592ISO10312Policy Scope
IN2.602ISO10313Policy Source
IN2.6160CXO1Patient Member Number
IN2.622ISO10063Guarantor s Relationship To Insured
IN2.6340XTNO*Insured s Telephone Number - Home
IN2.6440XTNO*Insured s Employer Telephone Number
IN2.652CEO1Military Handicapped Program
IN2.662IDO10136Suspend Flag
IN2.672IDO10136Co-pay Limit Flag
IN2.682IDO10136Stoploss Limit Flag
IN2.69130XONO*Insured Organization Name And ID
IN2.70130XONO*Insured Employer Organization Name And ID
IN2.711ISO10005Race
IN2.721IDO1Patient Relationship to Insured

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