INS

Subscriber Relationship

Pos: 110

Max: 1

Detail - Optional

Loop: 2100C

Elements: 7

	Ref	Id	Element Name	Req	Type	Min/Max	Usage
	INS01	1073	Yes/No Condition or Response Code Description: Code indicating a Yes or No condition or response Industry: Insured Indicator	M	ID	1/1	Required

INS02

1069

Individual Relationship Code
Description: Code indicating the relationship between two individuals or entities

2/2

Required

INS03

875

Maintenance Type Code
Description: Code identifying the specific type of item maintenance
Use this element (and code “25" in INS04) if any of the identifying elements for the subscriber have been changed from those submitted in the 270.

3/3

Situational

INS04

1203

Maintenance Reason Code
Description: Code identifying the reason for the maintenance change
Use this element (and code “001" in INS03) if any of the identifying elements for the subscriber have been changed from those submitted in the 270.

2/3

Situational

Code

Name

Change in Identifying Data Elements

Use this code to indicate that a change has been made to the primary elements that identify a specific person. Such elements are first name, last name, date of birth, identification numbers, and address.

	INS09	1220	Student Status Code Description: Code indicating the student status of the patient if 19 years of age or older, not handicapped and not the insured Use if available. All valid standard codes are used.	O	ID	1/1	Situational
	INS10	1073	Yes/No Condition or Response Code Description: Code indicating a Yes or No condition or response Industry: Handicap Indicator Use if available.	O	ID	1/1	Situational

	Code	Name
	N	No
	Y	Yes

INS17

1470

Number
Description: A generic number
Industry: Birth Sequence Number
Use to indicate the birth order in the event of multiple birth’s in association with the birth date supplied in DMG02.

1/9

Situational

1.	INS01 indicates status of the insured. A "Y" value indicates the insured is a subscriber: an "N" value indicates the insured is a dependent.
2.	INS10 is the handicapped status indicator. A "Y" value indicates an individual is handicapped; an "N" value indicates an individual is not handicapped.
3.	INS12 is the date of death.
4.	INS14, INS15, and INS16 identify where the employee works.
5.	INS17 is the number assigned to each family member born with the same birth date. This number identifies birth sequence for multiple births allowing proper tracking and response of benefits for each dependent (i.e., twins, triplets, etc.).

Notes:

1. Use this segment if necessary to convey insurance related information about the individual identified.
2. This segment may also be used to identify that the information source has changed some of the identifying elements for the subscriber that the information receiver submitted in the original 270 transaction.
3. Different types of health plans identify patients in different manners depending upon how their eligibility is structured. However, two approaches predominate.
The first approach is to assign each individual member of the family (and plan) a unique ID number. This number can be used to identify and access that individual’s information independent of whether he or she is a child, spouse, or the actual subscriber to the plan. In this approach, the patient can be identified at the subscriber or insured hierarchical level because a unique ID number exists to access eligibility information for this individual. The relationship if this individual to the actual subscriber or contract holder would be one of spouse, child, self, etc.
The second approach is to assign the actual subscriber or contract holder a unique ID number that is entered into the eligibility system. Any related spouse, children, or dependents are identified through he subscriber’s ID and have no unique identification number of their own. In this approach, the subscriber would be identified at the Loop 2100C subscriber or insured level, and the actual patient (spouse, child, etc.) would be identified at the Loop 2100D dependent level under the subscriber.

Example:

INS*Y*18*001*25~