EDI 186 Laboratory Reporting

Functional Group UW

X12N Insurance Subcommittee

This Draft Standard for Trial Use contains the format and establishes the data contents of the Laboratory Reporting Transaction Set (186) for use within the context of an Electronic Data Interchange (EDI) environment. The transaction set can be used to provide laboratory test results and associated information for the purpose of life and health insurance underwriting on an individual basis and to assist in the management and control of the collection, delivery, and testing of specimens.

Heading

Position
Segment
Name
Max use
  1. To indicate the start of a transaction set and to assign a control number

  2. To indicate the beginning of a transaction set.

  3. To specify the currency (dollars, pounds, francs, etc.) used in a transaction

    The CUR segment is used to designate the currency type used in monetary amounts in the transaction set.
  4. To describe laboratory testing results, normal result ranges, or both

    The LTR segment allows for transmitting expected ranges for all occurrences of a test in the transaction set.
  5. NM1 Loop Optional
    Repeat 2
    1. To supply the full name of an individual or organizational entity

      The NM1 loop allows for identifying the sender and receiver of the message and their respective account numbers.
    2. To specify the location of the named party

    3. To specify the geographic place of the named party

    4. To specify identifying numbers.

      The REF segment is used to convey regulatory licensing identification.
    5. To identify a person or office to whom administrative communications should be directed

Detail

Position
Segment
Name
Max use
  1. ACT Loop Mandatory
    Repeat >1
    1. To specify account information.

      The ACT loop occurs for each insurance company account, division, etc.
    2. LIN Loop Mandatory
      Repeat >1
      1. To specify basic item identification data.

        The LIN loop repeats for each individual report. The LIN segment includes the laboratory report number.
      2. To supply the full name of an individual or organizational entity

        The NM1 segment identifies the individual subject, including social security number. Additional NM1 segments identify the agent or broker responsible for the application.
      3. To specify identifying numbers.

        The REF segment includes the insurance company's identification (application number, policy number, etc.).
      4. To specify the location of the named party

        The N3, N4, and DMG segments apply to the individual applicant identified in the NM1 segment.
      5. To specify the geographic place of the named party

      6. To supply demographic information

      7. To specify any or all of a date, a time, or a time period

      8. To specify a code and the amount, quantity associated with it, or both

        The AM1 segment is used to describe the insurance coverage being requested. The AM1 segment is also used to advise report costs.
      9. To identify the type and transmission of paperwork or supporting information

        The PWK segment is used to indicate that additional paper reports have been sent.
      10. To transmit a fixed format record

      11. SPK Loop Mandatory
        Repeat >1
        1. To identify and describe laboratory specimen kit information and handling requirements

          The SPK loop is used to describe the specimen received by the laboratory.
        2. To provide characteristics that may have multiple values

        3. To transmit a fixed format record

        4. NM1 Loop Optional
          Repeat >1
          1. To supply the full name of an individual or organizational entity

            The NM1 information is used to describe the firm which collected and forwarded the specimen. The NM1 segment also identifies the paramedic who collected the specimen.
          2. To specify the geographic place of the named party

      12. LTR Loop Optional
        Repeat >1
        1. To describe laboratory testing results, normal result ranges, or both

          The LTR loop repeats for each individual test being reported and provides the results for each test.
        2. To provide characteristics that may have multiple values

        3. To specify any or all of a date, a time, or a time period

        4. To supply the full name of an individual or organizational entity

          The NM1 segments identifies the individuals or laboratory locations responsible for an individual test.
        5. To transmit a fixed format record

  2. To indicate the end of the transaction set and provide the count of the transmitted segments (including the beginning (ST) and ending (SE) segments).

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