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

1. 010 · ST · Transaction Set Header · Max 1 · Mandatory

   To indicate the start of a transaction set and to assign a control number

2. 020 · BGN · Beginning Segment · Max 1 · Mandatory

   To indicate the beginning of a transaction set.

3. 030 · CUR · Currency · Max 1 · Optional

   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. 040 · LTR · Laboratory Test Results · Max 99 · Optional

   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. 050 · NM1 · Individual or Organizational Name · Max 1 · Mandatory

      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. 060 · N3 · Address Information · Max 3 · Optional

      To specify the location of the named party

   3. 070 · N4 · Geographic Location · Max 1 · Optional

      To specify the geographic place of the named party

   4. 080 · REF · Reference Numbers · Max 9 · Optional

      To specify identifying numbers.

      The REF segment is used to convey regulatory licensing identification.

   5. 090 · PER · Administrative Communications Contact · Max 3 · Optional

      To identify a person or office to whom administrative communications should be directed

Detail

1. ACT Loop Mandatory Repeat >1

   1. 010 · ACT · Account Identification · Max 1 · Mandatory

      To specify account information.

      The ACT loop occurs for each insurance company account, division, etc.

   2. LIN Loop Mandatory Repeat >1

      1. 020 · LIN · Item Identification · Max 1 · Mandatory

         To specify basic item identification data.

         The LIN loop repeats for each individual report. The LIN segment includes the laboratory report number.

      2. 030 · NM1 · Individual or Organizational Name · Max 9 · Optional

         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. 040 · REF · Reference Numbers · Max 9 · Optional

         To specify identifying numbers.

         The REF segment includes the insurance company's identification (application number, policy number, etc.).

      4. 050 · N3 · Address Information · Max 3 · Optional

         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. 060 · N4 · Geographic Location · Max 1 · Optional

         To specify the geographic place of the named party

      6. 070 · DMG · Demographic Information · Max 1 · Optional

         To supply demographic information

      7. 080 · DTP · Date or Time or Period · Max 5 · Optional

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

      8. 090 · AM1 · Informational Values · Max 9 · Optional

         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. 110 · PWK · Paperwork · Max 1 · Optional

         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. 120 · K3 · File Information · Max 3 · Optional

          To transmit a fixed format record

      11. SPK Loop Mandatory Repeat >1

          1. 130 · SPK · Specimen Kit Information · Max 1 · Mandatory

             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. 140 · CD2 · Multi-Valued Characteristics · Max 9 · Optional

             To provide characteristics that may have multiple values

          3. 150 · K3 · File Information · Max 3 · Optional

             To transmit a fixed format record

          4. NM1 Loop Optional Repeat >1

             1. 160 · NM1 · Individual or Organizational Name · Max 1 · Mandatory

                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. 170 · N4 · Geographic Location · Max 1 · Optional

                To specify the geographic place of the named party

      12. LTR Loop Optional Repeat >1

          1. 180 · LTR · Laboratory Test Results · Max 1 · Mandatory

             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. 190 · CD2 · Multi-Valued Characteristics · Max 9 · Optional

             To provide characteristics that may have multiple values

          3. 200 · DTP · Date or Time or Period · Max 9 · Optional

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

          4. 210 · NM1 · Individual or Organizational Name · Max 9 · Optional

             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. 220 · K3 · File Information · Max 3 · Optional

             To transmit a fixed format record

2. 230 · SE · Transaction Set Trailer · Max 1 · Mandatory

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