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seqtypeoptdescriptionvalue
1OInsurance Rank’1’ - Primary ‘2’ - Secondary
2OInsurance company IDElectronic Payer ID if available, otherwise practice-specific insurance company ID assigned by Elation
3OInsurance company IDElectronic Payer ID if available, otherwise practice-specific insurance company ID assigned by Elation
4OInsurance Company Name
5.1OInsurance Company Address (Line 1)
5.2OInsurance Company Address (Line 2)
5.3OInsurance Company City
5.4OInsurance Company State
5.5OInsurance Company Zip Code
8OInsurance Group Number
9OInsurance Plan Name
16.1OLast Name of Insured
16.2OFirst Name of Insured
17OInsured’s Relationship to Patient’1’ - Self ‘2’ - Spouse ‘3’ - Other
19.1OInsured’s Street Address
19.3OInsured’s City
19.4OInsured’s State
19.5OInsured’s Zip
36OPolicy Number
This information (although marked optional) is typically included on the lab orders. Elation will send multiple insurance segments if they are present in Elation. 
IN1|1|811258067747182|811258067747182|DC MEDICARE|P.O. BOX 890396^^CAMP HILL^PA^170890398|||111111|PPO Plan||||||||1|||||||||||||||||||AABB1122 
IN1|2|60054|60054|AETNA|1800 ELM ST^^CARMEL^IN^460821935||||||||||||1|||||||||||||||||||CCDD334455