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| Item | DT | Card | Conf | Description | Label |
|---|---|---|---|---|---|
| hl7v2:IN3.1 | SI | 1 … 1 | Set ID - IN3 Contains 2.16.840.1.113883.3.1937.777.10.15.88 SI - Sequence ID (DYNAMIC) | IN3_ ment | |
| @Item | 0 … 1 | F | 502 | ||
| @Type | 0 … 1 | F | SI | ||
| @LongName | 0 … 1 | F | Set ID - IN3 | ||
| hl7v2:IN3.2 | CX | 0 … 1 | Certification Number Contains 2.16.840.1.113883.3.1937.777.10.15.12 CX - Extended composite ID with check digit (DYNAMIC) | IN3_ment | |
| @Item | 0 … 1 | F | 503 | ||
| @Type | 0 … 1 | F | CX | ||
| @LongName | 0 … 1 | F | Certification Number | ||
| hl7v2:IN3.3 | XCN | 0 … * | Certified By Contains 2.16.840.1.113883.3.1937.777.10.15.74 XCN - Extended composite ID number and name for persons (DYNAMIC) | IN3_ment | |
| @Item | 0 … 1 | F | 504 | ||
| @Type | 0 … 1 | F | XCN | ||
| @LongName | 0 … 1 | F | Certified By | ||
| hl7v2:IN3.4 | ID | 0 … 1 | Certification Required Contains 2.16.840.1.113883.3.1937.777.10.15.83 ID - Coded value for HL7 defined tables (DYNAMIC) | IN3_ment | |
| @Item | 0 … 1 | F | 505 | ||
| @Type | 0 … 1 | F | ID | ||
| @Table | 0 … 1 | F | HL70136 | ||
| @LongName | 0 … 1 | F | Certification Required | ||
| hl7v2:IN3.5 | MOP | 0 … 1 | Penalty Contains 2.16.840.1.113883.3.1937.777.10.15.35 MOP - Money or percentage (DYNAMIC) | IN3_ment | |
| @Item | 0 … 1 | F | 506 | ||
| @Type | 0 … 1 | F | MOP | ||
| @LongName | 0 … 1 | F | Penalty | ||
| hl7v2:IN3.6 | TS | 0 … 1 | Certification Date/Time Contains 2.16.840.1.113883.3.1937.777.10.15.64 TS - Time stamp (DYNAMIC) | IN3_ment | |
| @Item | 0 … 1 | F | 507 | ||
| @Type | 0 … 1 | F | TS | ||
| @LongName | 0 … 1 | F | Certification Date/Time | ||
| hl7v2:IN3.7 | TS | 0 … 1 | Certification Modify Date/Time Contains 2.16.840.1.113883.3.1937.777.10.15.64 TS - Time stamp (DYNAMIC) | IN3_ment | |
| @Item | 0 … 1 | F | 508 | ||
| @Type | 0 … 1 | F | TS | ||
| @LongName | 0 … 1 | F | Certification Modify Date/Time | ||
| hl7v2:IN3.8 | XCN | 0 … * | Operator Contains 2.16.840.1.113883.3.1937.777.10.15.74 XCN - Extended composite ID number and name for persons (DYNAMIC) | IN3_ment | |
| @Item | 0 … 1 | F | 509 | ||
| @Type | 0 … 1 | F | XCN | ||
| @LongName | 0 … 1 | F | Operator | ||
| hl7v2:IN3.9 | DT | 0 … 1 | Certification Begin Date Contains 2.16.840.1.113883.3.1937.777.10.15.80 DT - Date (DYNAMIC) | IN3_ment | |
| @Item | 0 … 1 | F | 510 | ||
| @Type | 0 … 1 | F | DT | ||
| @LongName | 0 … 1 | F | Certification Begin Date | ||
| hl7v2:IN3.10 | DT | 0 … 1 | Certification End Date Contains 2.16.840.1.113883.3.1937.777.10.15.80 DT - Date (DYNAMIC) | IN3_ment | |
| @Item | 0 … 1 | F | 511 | ||
| @Type | 0 … 1 | F | DT | ||
| @LongName | 0 … 1 | F | Certification End Date | ||
| hl7v2:IN3.11 | DTN | 0 … 1 | Days Contains 2.16.840.1.113883.3.1937.777.10.15.19 DTN - Day type and number (DYNAMIC) | IN3_ment | |
| @Item | 0 … 1 | F | 512 | ||
| @Type | 0 … 1 | F | DTN | ||
| @LongName | 0 … 1 | F | Days | ||
| hl7v2:IN3.12 | CE | 0 … 1 | Non-Concur Code/Description Contains 2.16.840.1.113883.3.1937.777.10.15.5 CE - Coded element (DYNAMIC) | IN3_ment | |
| @Item | 0 … 1 | F | 513 | ||
| @Type | 0 … 1 | F | CE | ||
| @Table | 0 … 1 | F | HL70233 | ||
| @LongName | 0 … 1 | F | Non-Concur Code/Description | ||
| hl7v2:IN3.13 | TS | 0 … 1 | Non-Concur Effective Date/Time Contains 2.16.840.1.113883.3.1937.777.10.15.64 TS - Time stamp (DYNAMIC) | IN3_ment | |
| @Item | 0 … 1 | F | 514 | ||
| @Type | 0 … 1 | F | TS | ||
| @LongName | 0 … 1 | F | Non-Concur Effective Date/Time | ||
| hl7v2:IN3.14 | XCN | 0 … * | Physician Reviewer Contains 2.16.840.1.113883.3.1937.777.10.15.74 XCN - Extended composite ID number and name for persons (DYNAMIC) | IN3_ment | |
| @Item | 0 … 1 | F | 515 | ||
| @Type | 0 … 1 | F | XCN | ||
| @Table | 0 … 1 | F | HL70010 | ||
| @LongName | 0 … 1 | F | Physician Reviewer | ||
| hl7v2:IN3.15 | ST | 0 … 1 | Certification Contact Contains 2.16.840.1.113883.3.1937.777.10.15.89 ST - String (DYNAMIC) | IN3_ment | |
| @Item | 0 … 1 | F | 516 | ||
| @Type | 0 … 1 | F | ST | ||
| @LongName | 0 … 1 | F | Certification Contact | ||
| hl7v2:IN3.16 | XTN | 0 … * | Certification Contact Phone Number Contains 2.16.840.1.113883.3.1937.777.10.15.77 XTN - Extended telecommunications number (DYNAMIC) | IN3_ment | |
| @Item | 0 … 1 | F | 517 | ||
| @Type | 0 … 1 | F | XTN | ||
| @LongName | 0 … 1 | F | Certification Contact Phone Number | ||
| hl7v2:IN3.17 | CE | 0 … 1 | Appeal Reason Contains 2.16.840.1.113883.3.1937.777.10.15.5 CE - Coded element (DYNAMIC) | IN3_ment | |
| @Item | 0 … 1 | F | 518 | ||
| @Type | 0 … 1 | F | CE | ||
| @Table | 0 … 1 | F | HL70345 | ||
| @LongName | 0 … 1 | F | Appeal Reason | ||
| hl7v2:IN3.18 | CE | 0 … 1 | Certification Agency Contains 2.16.840.1.113883.3.1937.777.10.15.5 CE - Coded element (DYNAMIC) | IN3_ment | |
| @Item | 0 … 1 | F | 519 | ||
| @Type | 0 … 1 | F | CE | ||
| @Table | 0 … 1 | F | HL70346 | ||
| @LongName | 0 … 1 | F | Certification Agency | ||
| hl7v2:IN3.19 | XTN | 0 … * | Certification Agency Phone Number Contains 2.16.840.1.113883.3.1937.777.10.15.77 XTN - Extended telecommunications number (DYNAMIC) | IN3_ment | |
| @Item | 0 … 1 | F | 520 | ||
| @Type | 0 … 1 | F | XTN | ||
| @LongName | 0 … 1 | F | Certification Agency Phone Number | ||
| hl7v2:IN3.20 | ICD | 0 … * | Pre-Certification Requirement Contains 2.16.840.1.113883.3.1937.777.10.15.29 ICD - Insurance certification definition (DYNAMIC) | IN3_ment | |
| @Item | 0 … 1 | F | 521 | ||
| @Type | 0 … 1 | F | ICD | ||
| @LongName | 0 … 1 | F | Pre-Certification Requirement | ||
| hl7v2:IN3.21 | ST | 0 … 1 | Case Manager Contains 2.16.840.1.113883.3.1937.777.10.15.89 ST - String (DYNAMIC) | IN3_ment | |
| @Item | 0 … 1 | F | 522 | ||
| @Type | 0 … 1 | F | ST | ||
| @LongName | 0 … 1 | F | Case Manager | ||
| hl7v2:IN3.22 | DT | 0 … 1 | Second Opinion Date Contains 2.16.840.1.113883.3.1937.777.10.15.80 DT - Date (DYNAMIC) | IN3_ment | |
| @Item | 0 … 1 | F | 523 | ||
| @Type | 0 … 1 | F | DT | ||
| @LongName | 0 … 1 | F | Second Opinion Date | ||
| hl7v2:IN3.23 | IS | 0 … 1 | Second Opinion Status Contains 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMIC) | IN3_ment | |
| @Item | 0 … 1 | F | 524 | ||
| @Type | 0 … 1 | F | IS | ||
| @Table | 0 … 1 | F | HL70151 | ||
| @LongName | 0 … 1 | F | Second Opinion Status | ||
| hl7v2:IN3.24 | IS | 0 … * | Second Opinion Documentation Received Contains 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMIC) | IN3_ment | |
| @Item | 0 … 1 | F | 525 | ||
| @Type | 0 … 1 | F | IS | ||
| @Table | 0 … 1 | F | HL70152 | ||
| @LongName | 0 … 1 | F | Second Opinion Documentation Received | ||
| hl7v2:IN3.25 | XCN | 0 … * | Second Opinion Physician Contains 2.16.840.1.113883.3.1937.777.10.15.74 XCN - Extended composite ID number and name for persons (DYNAMIC) | IN3_ment | |
| @Item | 0 … 1 | F | 526 | ||
| @Type | 0 … 1 | F | XCN | ||
| @Table | 0 … 1 | F | HL70010 | ||
| @LongName | 0 … 1 | F | Second Opinion Physician | ||