The IN3 segment carries the certification and managed-care detail that sits on top of the coverage described in IN1 and IN2: pre-certification and authorization numbers, who certified the care and when, the certified date span and number of days, utilization-review non-concurrence, appeals, second opinions, and the case manager. Where IN1 says who the payer is and IN2 fills in the subscriber and employer detail, IN3 records the payer's authorization decisions for the encounter.
Purpose
IN3 holds the insurance certification context for a single plan: the certification number and who issued it, whether certification was required, any penalty for non-compliance, the begin/end dates and number of certified days, utilization-review outcomes (non-concur code, appeal reason, second opinion), the reviewing physician(s), the certification agency and its contact details, and the case manager assigned to the patient. It repeats per IN1/IN2 coverage so each plan can carry its own authorization data.
Used in
IN3 appears in the insurance group of financial and visit messages, always after the IN1 (and optional IN2) it qualifies: ADT (admit and update events that carry coverage), DFT (detail financial transactions), and BAR (billing/account add and update). See ADT.
Field-by-field reference
Source: the Vorro HL7 segment database (extracted from the official v2-to-FHIR IG). R = required (cardinality min ≥ 1). Repeat = field may repeat. Length is not carried by the FHIR source and is shown as —.
| Seq | Name | Data Type | Length | Req | Repeat | Table # | Description |
|---|---|---|---|---|---|---|---|
| IN3-1 | Set ID - IN3 | SI | — | R | — | — | Sequence number when multiple IN3s appear; usually 1. |
| IN3-2 | Certification Number | CX | — | O | — | — | The pre-certification or authorization number from the payer. |
| IN3-3 | Certified By | XCN | — | O | Y | — | Person who certified the care. |
| IN3-4 | Certification Required | ID | — | O | — | — | Whether certification is required for this coverage. |
| IN3-5 | Penalty | MOP | — | O | — | — | Penalty applied when certification is missing. |
| IN3-6 | Certification Date/Time | DTM | — | O | — | — | When the certification was issued. |
| IN3-7 | Certification Modify Date/Time | DTM | — | O | — | — | When the certification was last modified. |
| IN3-8 | Operator | XCN | — | O | Y | — | Person who entered or modified the certification. |
| IN3-9 | Certification Begin Date | DT | — | O | — | — | First date the certification is effective. |
| IN3-10 | Certification End Date | DT | — | O | — | — | Last date the certification is effective. |
| IN3-11 | Days | DTN | — | O | — | — | Number of certified days by day type. |
| IN3-12 | Non-Concur Code/Description | CWE | — | O | — | HL70229 | Utilization-review non-concurrence code. |
| IN3-13 | Non-Concur Effective Date/Time | DTM | — | O | — | — | When the non-concurrence takes effect. |
| IN3-14 | Physician Reviewer | XCN | — | O | Y | — | Physician(s) who reviewed the certification. |
| IN3-15 | Certification Contact | ST | — | O | — | — | Name of the certification contact. |
| IN3-16 | Certification Contact Phone Number | XTN | — | O | Y | — | Phone number(s) for the certification contact. |
| IN3-17 | Appeal Reason | CWE | — | O | — | HL70345 | Reason an appeal was filed. |
| IN3-18 | Certification Agency | CWE | — | O | — | HL70346 | Agency that issued the certification. |
| IN3-19 | Certification Agency Phone Number | XTN | — | O | Y | — | Phone number(s) for the certification agency. |
| IN3-20 | Pre-Certification Requirement | ICD | — | O | Y | — | Pre-certification requirement detail per item. |
| IN3-21 | Case Manager | ST | — | O | — | — | Name of the case manager for the patient. |
| IN3-22 | Second Opinion Date | DT | — | O | — | — | Date a second opinion was obtained. |
| IN3-23 | Second Opinion Status | CWE | — | O | — | HL70151 | Status of the second opinion. |
| IN3-24 | Second Opinion Documentation Received | CWE | — | O | Y | HL70152 | Documentation received for the second opinion. |
| IN3-25 | Second Opinion Physician | XCN | — | O | Y | — | Physician(s) who gave the second opinion. |
| IN3-26 | Certification Type | CWE | — | O | — | HL70921 | Type of certification. |
| IN3-27 | Certification Category | CWE | — | O | — | HL70922 | Category of certification. |
Most-used fields
- IN3-1 Set ID - IN3 is the only required field; it ties the IN3 to its matching IN1/IN2 occurrence.
- IN3-2 Certification Number is the authorization number billing and claims systems match on for the encounter.
- IN3-4 Certification Required drives logic that flags care needing prior authorization.
- IN3-9 Certification Begin Date and IN3-10 Certification End Date bound the authorized service window.
- IN3-21 Case Manager is the one field with a published FHIR CareTeam mapping.
Version differences (2.3 to 2.8.2)
- 2.3/2.4: core certification fields (IN3-1 through IN3-25) established; utilization-review and second-opinion fields present.
- 2.5: coded fields move from
CEtowardCWE; IN3-5 Penalty data type (MOP) clarified. - 2.7+: IN3-26 Certification Type and IN3-27 Certification Category added.
- Receivers built for 2.3 ignore the trailing fields they do not recognize.
Common mistakes
- Sending IN3 without the preceding IN1/IN2, leaving the certification with no coverage to attach to.
- Losing the IN3-1 Set ID, so a multi-plan message cannot align certifications to the right insurance.
- Treating IN3-2 as free text and dropping the
CXassigning-authority components. - Reading only the first repetition of IN3-3/IN3-14/IN3-25 when several reviewers are listed.
Examples
Minimal valid IN3 (only the required Set ID):
IN3|1
Fully-populated IN3 (certified inpatient stay):
IN3|1|CERT00789^^^MERCYPLAN|9001^REED^ANNE^^^^MD|Y||20260609100000|20260609100000|9100^OPER^SAM|20260609|20260616|7^DA||||UR^^^^^^^Mercy UR|^^^urcontact@mercyplan.example|||MERCY UTILIZATION REVIEW^^HL70346|^^^^^555^5550100||CASEMGR PAT JONES|20260608|AC^Accepted
Annotated breakdown of the fully-populated example (selected fields):
IN3 ← segment ID
1 ← IN3-1 Set ID
CERT00789^^^MERCYPLAN ← IN3-2 Certification Number
9001^REED^ANNE^^^^MD ← IN3-3 Certified By
Y ← IN3-4 Certification Required
20260609100000 ← IN3-6 Certification Date/Time
20260609 ← IN3-9 Certification Begin Date
20260616 ← IN3-10 Certification End Date
7^DA ← IN3-11 Days
CASEMGR PAT JONES ← IN3-21 Case Manager
20260608 ← IN3-22 Second Opinion Date
AC^Accepted ← IN3-23 Second Opinion Status
In-context inside an ADT^A01 (admit, IN3 after IN1/IN2):
MSH|^~&|REG|MERCYGEN|EHR|MERCYGEN|20260609120000||ADT^A01^ADT_A01|MSG001|P|2.5.1
EVN|A01|20260609120000
PID|1||MR12345^^^MERCYGEN^MR||DOE^JOHN^Q||19800101|M
IN1|1|PLAN01^Mercy PPO|MERCYPLAN|Mercy Health Plan|||||||||20260101||||DOE^JOHN^Q|SE|19800101
IN2|1|123456789|GRP44^Acme Corp
IN3|1|CERT00789^^^MERCYPLAN|9001^REED^ANNE^^^^MD|Y||20260609100000||20260609|20260616|7^DA|||||||||||CASEMGR PAT JONES
In-context inside a DFT^P03 (post detail financial transaction, IN3 after IN1/IN2):
MSH|^~&|BILL|MERCYGEN|FIN|MERCYGEN|20260612080000||DFT^P03^DFT_P03|MSG045|P|2.5.1
EVN|P03|20260612080000
PID|1||MR12345^^^MERCYGEN^MR||DOE^JOHN^Q||19800101|M
IN1|1|PLAN01^Mercy PPO|MERCYPLAN|Mercy Health Plan|||||||||20260101||||DOE^JOHN^Q|SE|19800101
IN2|1|123456789|GRP44^Acme Corp
IN3|1|CERT00789^^^MERCYPLAN||Y||20260609100000||20260609|20260616|7^DA|||||||||||CASEMGR PAT JONES
FHIR mapping
Primary target resource: CareTeam. The published v2-to-FHIR ConceptMap for IN3 is narrow — it maps only IN3-21 Case Manager onto a CareTeam participant. Official ConceptMap: CareTeam.
Key CareTeam mappings:
| IN3 field | FHIR target (CareTeam) |
|---|---|
| IN3-21 Case Manager | CareTeam.participant.role.coding (SNOMED 768832004, system http://snomed.info/sct) + CareTeam.participant.role.text (case manager) |
Other targets: none published. The certification, utilization-review, second-opinion, and agency fields (IN3-1 through IN3-20 and IN3-22 through IN3-27) have no published FHIR mapping in this ConceptMap; they are authorization/financial details not represented on CareTeam.
Engine considerations
- Required in practice: only IN3-1 is standard-required, but real interfaces also require IN3-2 (certification number) and the begin/end dates for authorization tracking.
- Keep IN3 aligned to its IN1/IN2 occurrence via the shared Set ID so multi-plan messages stay coherent.
- Parse IN3-2 as a structured
CXso the assigning authority survives. - Repeating reviewer and contact fields (IN3-3/8/14/16/19/20/24/25) must be preserved as arrays.
How Vorro parses and produces IN3
Vorro keeps each IN3 paired with its IN1/IN2 coverage by Set ID and indexes IN3-2 as the authorization key so charges and claims attach to the correct certification. Repeating reviewer, contact, and agency fields are preserved as arrays, date fields are normalized, and on the FHIR side Vorro emits a CareTeam participant from IN3-21 Case Manager per the official ConceptMap, leaving the unmapped certification fields available for downstream financial routing.
Related pages
- IN1 — the primary insurance/coverage the certification attaches to.
- IN2 — additional insurance, subscriber, and employer detail.
- ADT messages — where IN1/IN2/IN3 carry coverage on admit and update events.
