IN2.1_Insured_s_Employee_IDSequential Number: 1
Description: Insured's Employee ID
Data Type: CX
Item ID: 472
Sequential Number: 2
Description: Insured's Social Security Number
Data Type: ST
Item ID: 473
IN2.3_Insured_s_Employer_s_Name_and_IDSequential Number: 3
Description: Insured's Employer's Name and ID
Data Type: XCN
Item ID: 474
Sequential Number: 4
Description: Employer Information Data
Data Type: CWE
Item ID: 475
Table: 0139
IN2.5_Mail_Claim_PartySequential Number: 5
Description: Mail Claim Party
Data Type: CWE
Item ID: 476
Table: 0137
Sequential Number: 6
Description: Medicare Health Ins Card Number
Data Type: ST
Item ID: 477
IN2.7_Medicaid_Case_NameSequential Number: 7
Description: Medicaid Case Name
Data Type: XPN
Item ID: 478
Sequential Number: 8
Description: Medicaid Case Number
Data Type: ST
Item ID: 479
IN2.9_Military_Sponsor_NameSequential Number: 9
Description: Military Sponsor Name
Data Type: XPN
Item ID: 480
Sequential Number: 10
Description: Military ID Number
Data Type: ST
Item ID: 481
Sequential Number: 11
Description: Dependent Of Military Recipient
Data Type: CWE
Item ID: 482
Table: 0342
Sequential Number: 12
Description: Military Organization
Data Type: ST
Item ID: 483
Sequential Number: 13
Description: Military Station
Data Type: ST
Item ID: 484
Sequential Number: 14
Description: Military Service
Data Type: CWE
Item ID: 485
Table: 0140
Sequential Number: 15
Description: Military Rank/Grade
Data Type: CWE
Item ID: 486
Table: 0141
Sequential Number: 16
Description: Military Status
Data Type: CWE
Item ID: 487
Table: 0142
Sequential Number: 17
Description: Military Retire Date
Data Type: DT
Item ID: 488
Sequential Number: 18
Description: Military Non-Avail Cert On File
Data Type: ID
Item ID: 489
Table: 0136
Sequential Number: 19
Description: Baby Coverage
Data Type: ID
Item ID: 490
Table: 0136
Sequential Number: 20
Description: Combine Baby Bill
Data Type: ID
Item ID: 491
Table: 0136
Sequential Number: 21
Description: Blood Deductible
Data Type: ST
Item ID: 492
IN2.22_Special_Coverage_Approval_NameSequential Number: 22
Description: Special Coverage Approval Name
Data Type: XPN
Item ID: 493
Sequential Number: 23
Description: Special Coverage Approval Title
Data Type: ST
Item ID: 494
IN2.24_Non-Covered_Insurance_CodeSequential Number: 24
Description: Non-Covered Insurance Code
Data Type: CWE
Item ID: 495
Table: 0143
IN2.25_Payor_IDSequential Number: 25
Description: Payor ID
Data Type: CX
Item ID: 496
IN2.26_Payor_Subscriber_IDSequential Number: 26
Description: Payor Subscriber ID
Data Type: CX
Item ID: 497
Sequential Number: 27
Description: Eligibility Source
Data Type: CWE
Item ID: 498
Table: 0144
IN2.28_Room_Coverage_Type_AmountSequential Number: 28
Description: Room Coverage Type/Amount
Data Type: RMC
Item ID: 499
IN2.29_Policy_Type_AmountSequential Number: 29
Description: Policy Type/Amount
Data Type: PTA
Item ID: 500
Sequential Number: 30
Description: Daily Deductible
Data Type: DDI
Item ID: 501
Sequential Number: 31
Description: Living Dependency
Data Type: CWE
Item ID: 755
Table: 0223
IN2.32_Ambulatory_StatusSequential Number: 32
Description: Ambulatory Status
Data Type: CWE
Item ID: 145
Table: 0009
IN2.33_CitizenshipSequential Number: 33
Description: Citizenship
Data Type: CWE
Item ID: 129
Table: 0171
Sequential Number: 34
Description: Primary Language
Data Type: CWE
Item ID: 118
Table: 0296
Sequential Number: 35
Description: Living Arrangement
Data Type: CWE
Item ID: 742
Table: 0220
Sequential Number: 36
Description: Publicity Code
Data Type: CWE
Item ID: 743
Table: 0215
Sequential Number: 37
Description: Protection Indicator
Data Type: ID
Item ID: 744
Table: 0136
Sequential Number: 38
Description: Student Indicator
Data Type: CWE
Item ID: 745
Table: 0231
Sequential Number: 39
Description: Religion
Data Type: CWE
Item ID: 120
Table: 0006
IN2.40_Mother_s_Maiden_NameSequential Number: 40
Description: Mother's Maiden Name
Data Type: XPN
Item ID: 109
Sequential Number: 41
Description: Nationality
Data Type: CWE
Item ID: 739
Table: 0212
IN2.42_Ethnic_GroupSequential Number: 42
Description: Ethnic Group
Data Type: CWE
Item ID: 125
Table: 0189
IN2.43_Marital_StatusSequential Number: 43
Description: Marital Status
Data Type: CWE
Item ID: 119
Table: 0002
Sequential Number: 44
Description: Insured's Employment Start Date
Data Type: DT
Item ID: 787
Sequential Number: 45
Description: Employment Stop Date
Data Type: DT
Item ID: 783
Sequential Number: 46
Description: Job Title
Data Type: ST
Item ID: 785
Sequential Number: 47
Description: Job Code/Class
Data Type: JCC
Item ID: 786
Sequential Number: 48
Description: Job Status
Data Type: CWE
Item ID: 752
Table: 0311
IN2.49_Employer_Contact_Person_NameSequential Number: 49
Description: Employer Contact Person Name
Data Type: XPN
Item ID: 789
IN2.50_Employer_Contact_Person_Phone_NumberSequential Number: 50
Description: Employer Contact Person Phone Number
Data Type: XTN
Item ID: 790
Sequential Number: 51
Description: Employer Contact Reason
Data Type: CWE
Item ID: 791
Table: 0222
IN2.52_Insured_s_Contact_Person_s_NameSequential Number: 52
Description: Insured's Contact Person's Name
Data Type: XPN
Item ID: 792
IN2.53_Insured_s_Contact_Person_Phone_NumberSequential Number: 53
Description: Insured's Contact Person Phone Number
Data Type: XTN
Item ID: 793
IN2.54_Insured_s_Contact_Person_ReasonSequential Number: 54
Description: Insured's Contact Person Reason
Data Type: CWE
Item ID: 794
Table: 0222
Sequential Number: 55
Description: Relationship to the Patient Start Date
Data Type: DT
Item ID: 795
IN2.56_Relationship_to_the_Patient_Stop_DateSequential Number: 56
Description: Relationship to the Patient Stop Date
Data Type: DT
Item ID: 796
Sequential Number: 57
Description: Insurance Co Contact Reason
Data Type: CWE
Item ID: 797
Table: 0232
IN2.58_Insurance_Co_Contact_Phone_NumberSequential Number: 58
Description: Insurance Co Contact Phone Number
Data Type: XTN
Item ID: 798
Sequential Number: 59
Description: Policy Scope
Data Type: CWE
Item ID: 799
Table: 0312
Sequential Number: 60
Description: Policy Source
Data Type: CWE
Item ID: 800
Table: 0313
Sequential Number: 61
Description: Patient Member Number
Data Type: CX
Item ID: 801
Sequential Number: 62
Description: Guarantor's Relationship to Insured
Data Type: CWE
Item ID: 802
Table: 0063
IN2.63_Insured_s_Phone_Number_-_HomeSequential Number: 63
Description: Insured's Phone Number - Home
Data Type: XTN
Item ID: 803
IN2.64_Insured_s_Employer_Phone_NumberSequential Number: 64
Description: Insured's Employer Phone Number
Data Type: XTN
Item ID: 804
Sequential Number: 65
Description: Military Handicapped Program
Data Type: CWE
Item ID: 805
Table: 0343
Sequential Number: 66
Description: Suspend Flag
Data Type: ID
Item ID: 806
Table: 0136
Sequential Number: 67
Description: Copay Limit Flag
Data Type: ID
Item ID: 807
Table: 0136
Sequential Number: 68
Description: Stoploss Limit Flag
Data Type: ID
Item ID: 808
Table: 0136
IN2.69_Insured_Organization_Name_and_IDSequential Number: 69
Description: Insured Organization Name and ID
Data Type: XON
Item ID: 809
IN2.70_Insured_Employer_Organization_Name_and_IDSequential Number: 70
Description: Insured Employer Organization Name and ID
Data Type: XON
Item ID: 810
IN2.71_RaceSequential Number: 71
Description: Race
Data Type: CWE
Item ID: 113
Table: 0005
Sequential Number: 72
Description: Patient's Relationship to Insured
Data Type: CWE
Item ID: 811
Table: 0344
any