Insurance Identifier
Insurance_identifier
Introduction
The Insurance Identifier data model is a fundamental component in healthcare information systems, designed to capture and manage essential information that identifies a patient's insurance coverage and related details. This model focuses on the IN1 (Insurance) and IN2 (Insurance Additional Information) segments of HL7 messages, providing a structured approach to handling insurance-related data. It plays a crucial role in ensuring accurate patient identification, billing, claims processing, and coordination of benefits.
Use Case
Developers can leverage the capabilities of the Insurance Identifier data model for various technical use cases, enabling efficient management of insurance identification data within healthcare systems:
- Patient Insurance Verification: Developers can use this model to query insurance IDs and patient IDs, allowing for efficient verification of a patient's insurance coverage. This is crucial for ensuring that patients have valid insurance information on file.
- Claims Processing: Healthcare systems often require accurate and timely claims processing. Developers can extract insurance identification data, including ID types, ID values, and start/end dates, to support the creation and submission of insurance claims.
- Patient Matching and Linking: Insurance identifiers provide a key mechanism for linking patient records. Developers can use this data to improve patient matching algorithms, ensuring that records are correctly associated with the right insurance coverage.
- Coordination of Benefits: In cases where a patient has multiple insurance policies, developers can use this model to identify and manage multiple insurance IDs, facilitating the coordination of benefits. This ensures that claims are submitted correctly to primary and secondary insurance providers.
- Patient Billing: Developers can extract insurance ID details to facilitate patient billing. This includes using the appropriate insurance ID type and value when generating invoices and statements for patients.
- Insurance Analytics: Researchers and analysts can query insurance identification data for research and analytics purposes. This data can be used to analyze trends in insurance types, coverage durations, and patient demographics.
- Compliance and Auditing: Developers can use this model to support compliance with healthcare regulations by querying insurance identification data for auditing and reporting purposes. This helps ensure that insurance-related processes adhere to regulatory requirements.
- Telemedicine and Remote Services: In telemedicine and remote healthcare scenarios, developers can access insurance identification data to verify patient insurance coverage for remote services and tele-health consultations.
- Data Migration: During data migration efforts, developers can use insurance identification data to map and transfer insurance-related information from legacy systems to new healthcare platforms.
Data Fields
| Attribute Name | Description | HL7 Mapping | Data Type | Label | Use Case |
|---|---|---|---|---|---|
| insurance_id | Id of Insurance | IN1+MSH-10 | string | Insurance ID | The "Insurance ID" field contains a unique identifier for the patient's insurance coverage. It helps link the patient to their insurance plan and benefits. |
| batch_id | Batch id | System Generated | string | Batch ID | "batch ID" is a unique identifier assigned to a group of messages that are logically grouped together for processing or transmission. Batching messages is a common practice in healthcare systems to efficiently manage and transmit multiple messages as a single unit |
| end_date | This is end_date attribute | System Generated | date | End date associated with ID, if any | The "End Date" can be used to indicate the date on which a particular treatment or medical procedure was completed or ended. This information is important for tracking the duration of medical interventions. |
| xc_visit_id | XC visit id | Based on alternate_visit_id followed by visit_number followed by system generated ID | string | XC visit id | The "xc_visit_id" is a unique identifier used to group together all the interactions, procedures, tests, and check-ups associated with a single patient visit in a healthcare setting. This identifier helps in organising and managing various activities and data related to that specific patient encounter. |
| id_type | Name of ID Type | IN1-2 | string | Name of ID Type | The "ID Type" field is used to specify the type of identification document or number associated with the patient, such as a driver's license, Social Security number, or passport. |
| id_value | This is id_value attribute | IN1-2 | string | ID # | The "ID Value" field is used to specify the actual value or number associated with the patient's identification document or identifier type specified in the "ID Type" field (IN1-2). |
| bundle_id | ID of bundle | MSH-10 | string | Bundle ID | “bundle ID" typically refers to a unique identifier assigned to a group or bundle of related messages or data elements. This identifier is used to associate multiple messages or pieces of information that are related to a specific patient, event, or transaction. |
| visit_number | Id of the visit | PV1-19-1 | string | Visit Number | The visit number serves as a unique identifier for a specific patient visit or encounter within a healthcare facility. It distinguishes one visit from another. |
| patient_id | This is patient_id attribute | PID-3-1 | string | Patient ID | The patient ID is a unique identifier assigned to a patient within the healthcare system. It is used to accurately identify and link a patient's medical records, treatments, and history. |
| start_date | This is start_date attribute | System Generated | date | Start date associated with ID, if any | The "Start Date" can be used to indicate the date on which a particular treatment, medical procedure, or healthcare service began. It is crucial for tracking the timing of medical interventions. |
| id_type_code | Code of ID type | IN1-2 | string | Code of ID Type | The "ID Type Code" field is used to specify the type of identification document or identifier associated with the patient. It indicates what type of ID is being used, such as a driver's license, Social Security number, passport, or other forms of identification. |
| identifier_id | This is identifier_id attribute | System Generated | string | Identifier ID | "Identifier ID" in the context of healthcare data typically refers to a unique identification code or number associated with a specific entity, such as a patient, provider, or an item. This code serves as a means of uniquely identifying that entity within a healthcare system. |
| alternate_visit_id | Alternative visit id | PV1-50/PID-18 | string | Alternate Visit Id | This field provides an alternate identifier for a patient's visit. It is used for tracking and cross-referencing patient visits and records, especially in scenarios requiring multiple identifiers or references. This field is recorded during patient registration and aids in accurate record linkage. |
| lineage | This is lineage attribute | Fixed - HL7 | string | Lineage | "lineage" refers to the information about the origin or source of a message. It helps trace the path of the message, indicating where it originated, how it was transmitted, and any intermediate systems or components it passed through before reaching its destination. |