EDI 255 Insurance Underwriting Information Services

Functional Group UI

X12N Insurance Subcommittee

This Draft Standard for Trial Use contains the format and establishes the data contents of the Insurance Underwriting Information Services Transaction Set (255) for use within the context of an Electronic Data Interchange (EDI) environment. This standard can be used to request specific services from information providers in support of the insurance underwriting process. In addition, the standard can be used between trading partners to request/receive status information on outstanding requests.

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

4. NM1 Loop Optional Repeat 9

   1. 040 · NM1 · Individual or Organizational Name · Max 1 · Mandatory

      To supply the full name of an individual or organizational entity

      The NM1 loop allows for one or more insurance companies to request the same information.

   2. 050 · N3 · Address Information · Max 2 · Optional

      To specify the location of the named party

   3. 060 · N4 · Geographic Location · Max 1 · Optional

      To specify the geographic place of the named party

   4. 070 · REF · Reference Identification · Max 9 · Optional

      To specify identifying information

   5. 080 · 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 is the primary loop for the requested services. It is based on the procurement of services for a unique policy/application/account or other unique identifier for one or more proposed insureds. The ACT segment contains the case identification.

   2. 020 · AM1 · Informational Values · Max 9 · Optional

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

   3. 030 · PWK · Paperwork · Max 1 · Optional

      To identify the type and transmission of paperwork or supporting information

   4. 040 · REF · Reference Identification · Max 9 · Optional

      To specify identifying information

   5. 050 · PER · Administrative Communications Contact · Max 3 · Optional

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

   6. 060 · DTM · Date/Time Reference · Max 9 · Optional

      To specify pertinent dates and times

   7. 070 · MSG · Message Text · Max 9 · Optional

      To provide a free-form format that allows the transmission of text information

   8. NM1 Loop Mandatory Repeat >1

      1. 080 · NM1 · Individual or Organizational Name · Max 1 · Mandatory

         To supply the full name of an individual or organizational entity

         The NM1 loop contains proposed insured's name, address & other information necessary to identify him/her. It is possible that there may be be multiple proposed insureds within a policy number in one ACT loop.

      2. 090 · N2 · Additional Name Information · Max 3 · Optional

         To specify additional names or those longer than 35 characters in length

      3. 100 · N3 · Address Information · Max 3 · Optional

         To specify the location of the named party

      4. 110 · N4 · Geographic Location · Max 1 · Optional

         To specify the geographic place of the named party

      5. 120 · ASI · Action or Status Indicator · Max 1 · Optional

         To indicate the action to be taken with the information provided or the status of the entity described

      6. 130 · PER · Administrative Communications Contact · Max 3 · Optional

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

      7. 140 · DMG · Demographic Information · Max 1 · Optional

         To supply demographic information

      8. 150 · IND · Additional Individual Demographic Information · Max 1 · Optional

         To provide additional demographic information to the receiving school, institution, or agency to assist in identifying the particular student

      9. 160 · CD2 · Multi-Valued Characteristics · Max 9 · Optional

         To provide characteristics that may have multiple values

      10. 170 · MSG · Message Text · Max 9 · Optional

          To provide a free-form format that allows the transmission of text information

      11. EFI Loop Optional Repeat >1

          1. 180 · EFI · Electronic Format Identification · Max 1 · Mandatory

             To provide basic information about the electronic format of the interchange data

             The EFI is included to provide a vehicle for capturing the proposed insured's signature to authorize specific services.

          2. 200 · BIN · Binary Data · Max 1 · Optional

             To transfer binary data in a single data segment and allow identification of the end of the data segment through a count; there is no identification of the internal structure of the binary data in this segment

      12. PO1 Loop Optional Repeat >1

          1. 210 · PO1 · Baseline Item Data · Max 1 · Mandatory

             To specify basic and most frequently used line item data

             The PO1 loop contains services requested to be performed by the information provider.

          2. 220 · ASI · Action or Status Indicator · Max 1 · Optional

             To indicate the action to be taken with the information provided or the status of the entity described

          3. 230 · DMA · Additional Demographic Information · Max 9 · Optional

             To supply additional demographic identification

          4. 240 · REF · Reference Identification · Max 9 · Optional

             To specify identifying information

          5. 250 · DTP · Date or Time or Period · Max 9 · Optional

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

          6. 260 · MSG · Message Text · Max 9 · Optional

             To provide a free-form format that allows the transmission of text information

          7. 265 · LS · Loop Header · Max 1 · Optional

             To indicate that the next segment begins a loop

          8. LX Loop Optional Repeat >1

             1. 270 · LX · Assigned Number · Max 1 · Mandatory

                To reference a line number in a transaction set

                The LX loop contains detailed information sources used by the information provider in completing their assignments. These could be doctors, clinics, employers, and other references. The LX segment is used as a unique reference number within the PO1 loop.

             2. 280 · NM1 · Individual or Organizational Name · Max 1 · Mandatory

                To supply the full name of an individual or organizational entity

             3. 290 · N2 · Additional Name Information · Max 3 · Optional

                To specify additional names or those longer than 35 characters in length

             4. 300 · N3 · Address Information · Max 3 · Optional

                To specify the location of the named party

             5. 310 · N4 · Geographic Location · Max 1 · Optional

                To specify the geographic place of the named party

             6. 320 · IND · Additional Individual Demographic Information · Max 1 · Optional

                To provide additional demographic information to the receiving school, institution, or agency to assist in identifying the particular student

             7. 330 · EMS · Employment Position · Max 1 · Optional

                To describe employment position

             8. 340 · PER · Administrative Communications Contact · Max 3 · Optional

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

             9. 350 · CN1 · Contract Information · Max 1 · Optional

                To specify basic data about the contract or contract line item

             10. 360 · DTP · Date or Time or Period · Max 9 · Optional

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

             11. 370 · CD2 · Multi-Valued Characteristics · Max 9 · Optional

                 To provide characteristics that may have multiple values

             12. 380 · REF · Reference Identification · Max 9 · Optional

                 To specify identifying information

             13. 390 · PWK · Paperwork · Max 1 · Optional

                 To identify the type and transmission of paperwork or supporting information

             14. 400 · MSG · Message Text · Max 9 · Optional

                 To provide a free-form format that allows the transmission of text information

          9. 405 · LE · Loop Trailer · Max 1 · Optional

             To indicate that the loop immediately preceding this segment is complete

2. 410 · 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)