EDI 186 Insurance Underwriting Requirements Reporting

Functional Group UW

X12N Insurance Subcommittee

This Draft Standard for Trial Use contains the format and establishes the data contents of the Insurance Underwriting Requirements Reporting Transaction Set (186) for use within the context of an Electronic Data Interchange (EDI) environment. The standard can be used by the information providers to report the results of specific services to their trading partners for information to complete the insurance underwriting process on individually underwritten life and health insurance.

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. 1000 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 1000 loop allows for identifying the sender and the 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 Identification · Max 9 · Optional

      To specify identifying information

      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. 2000 Loop Mandatory Repeat >1

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

      To specify account information

      The 2000 loop occurs for each insurance company account, division, etc.

   2. 2050 Loop Mandatory Repeat >1

      1. 020 · LX · Assigned Number · Max 1 · Mandatory

         To reference a line number in a transaction set

         The 2050 loop contains information about the proposed insured.

      2. 2075 Loop Mandatory Repeat >1

         1. 030 · NM1 · Individual or Organizational Name · Max 1 · Mandatory

            To supply the full name of an individual or organizational entity

            The 2075 loop identifies the proposed insured, including social security number. Additional 2075 loops can be used to identify additional entities associated with the proposed insured's application for insurance such as the agent or underwriter.

         2. 040 · REF · Reference Identification · Max >1 · Optional

            To specify identifying information

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

         3. 050 · N3 · Address Information · Max 1 · Optional

            To specify the location of the named party

            The N3 segment applies to the individual applicant identified in the NM1 segment at 2/030.

         4. 060 · N4 · Geographic Location · Max 1 · Optional

            To specify the geographic place of the named party

            The N4 segment applies to the individual applicant identified in the NM1 segment at 2/030.

         5. 070 · DMG · Demographic Information · Max 1 · Optional

            To supply demographic information

            The DMG segment applies to the individual applicant identified in the NM1 segment at 2/030.

         6. 080 · DTP · Date or Time or Period · Max 5 · Optional

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

         7. 090 · AM1 · Informational Values · Max 9 · Optional

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

            The AM1 segment is used to describe the insurance coverage being requested. The AM1 segment is also used to advise report costs.

         8. 100 · PWK · Paperwork · Max 1 · Optional

            To identify the type or transmission or both of paperwork or supporting information

            The PWK segment is used to indicate that additional paper reports have been sent.

         9. 110 · MSG · Message Text · Max >1 · Optional

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

         10. 120 · DMA · Additional Demographic Information · Max 1 · Optional

             To supply additional demographic identification

             The DMA segment applies to the individual applicant identified in the NM1 segment at 2/030.

         11. 130 · QTY · Quantity · Max >1 · Optional

             To specify quantity information

             The QTY segment applies to the individual applicant identified in the NM1 segment at 2/030.

      3. 2100 Loop Mandatory Repeat >1

         1. 140 · BOR · Beginning of Report · Max 1 · Mandatory

            To identify characteristic information of the report being transmitted

            The 2100 loop repeats for each individual report. The BOR segment includes the type of report and laboratory/information provider report number.

         2. 150 · DTP · Date or Time or Period · Max >1 · Optional

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

         3. 160 · MSG · Message Text · Max >1 · Optional

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

            The MSG segment sends the narrative version of the individual report as required by the Fair Credit Reporting Act.

         4. 2150 Loop Optional Repeat >1

            1. 170 · NM1 · Individual or Organizational Name · Max 1 · Mandatory

               To supply the full name of an individual or organizational entity

               The 2150 loop is to identify entities involved in creating the report. If this data goes through a clearinghouse, this segment can also be used to maintain the original information provider which was originally stored in the NM1 at 1/050.

            2. 180 · REF · Reference Identification · Max >1 · Optional

               To specify identifying information

               The REF segment is repeated to capture multiple identification numbers for the entity identified in the NM1 at 2/170.

            3. 190 · PER · Administrative Communications Contact · Max 1 · Optional

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

            4. 200 · N3 · Address Information · Max 1 · Optional

               To specify the location of the named party

            5. 210 · N4 · Geographic Location · Max 1 · Optional

               To specify the geographic place of the named party

            6. 220 · DMA · Additional Demographic Information · Max 1 · Optional

               To supply additional demographic identification

               The DMA segment identifies the language spoken by the proposed insured.

            7. 230 · REL · Relationship · Max 1 · Optional

               To specify relationship and birth order of entity

               The REL segment identifies the relationship between the proposed insured and interpreter.

         5. 2200 Loop Optional Repeat >1

            1. 240 · SPK · Specimen Kit Information · Max 1 · Mandatory

               To identify and describe laboratory specimen kit information and handling requirements

               The 2200 loop is used to describe the specimen received by the laboratory.

            2. 250 · CD2 · Multi-Valued Characteristics · Max 9 · Optional

               To provide characteristics that may have multiple values

            3. 260 · DTP · Date or Time or Period · Max 9 · Optional

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

            4. 270 · REF · Reference Identification · Max 1 · Optional

               To specify identifying information

            5. 280 · MSG · Message Text · Max >1 · Optional

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

            6. 2250 Loop Optional Repeat >1

               1. 290 · NM1 · Individual or Organizational Name · Max 1 · Mandatory

                  To supply the full name of an individual or organizational entity

                  The 2250 loop is used to identify the firm which collected and forwarded the specimen and the paramedic who collected the specimen.

               2. 300 · N4 · Geographic Location · Max 1 · Optional

                  To specify the geographic place of the named party

         6. 2300 Loop Optional Repeat >1

            1. 310 · LTR · Laboratory Test Results · Max 1 · Mandatory

               To describe laboratory testing results, normal result ranges, or both

               The 2300 loop repeats for each individual test being reported and provides the results for each test.

            2. 320 · CD2 · Multi-Valued Characteristics · Max 9 · Optional

               To provide characteristics that may have multiple values

            3. 330 · DTP · Date or Time or Period · Max 9 · Optional

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

            4. 340 · NM1 · Individual or Organizational Name · Max 9 · Optional

               To supply the full name of an individual or organizational entity

               The NM1 segment identifies the individuals or laboratory locations responsible for an individual test.

            5. 350 · MSG · Message Text · Max >1 · Optional

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

         7. 2350 Loop Optional Repeat >1

            1. 360 · UC · Underwriting Category · Max 1 · Mandatory

               To identify the category of underwriting data being transmitted

               The 2350 loop categorizes the information being reported in this and subordinate loops.

            2. 2400 Loop Optional Repeat >1

               1. 370 · HL · Hierarchical Level · Max 1 · Mandatory

                  To identify dependencies among and the content of hierarchically related groups of data segments

                  The 2400 loop allows relationships among hierarchically-related groups of information about the insurance applicant.

               2. 380 · UQS · Underwriting Question · Max 1 · Optional

                  To report information provider underwriting data in a question and answer format

                  The UQS segment allows information providers to send unique questions.

               3. 390 · NM1 · Individual or Organizational Name · Max 1 · Optional

                  To supply the full name of an individual or organizational entity

               4. 400 · N1 · Name · Max 1 · Optional

                  To identify a party by type of organization, name, and code

               5. 410 · N3 · Address Information · Max 1 · Optional

                  To specify the location of the named party

               6. 420 · N4 · Geographic Location · Max 1 · Optional

                  To specify the geographic place of the named party

               7. 430 · DTP · Date or Time or Period · Max >1 · Optional

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

               8. 440 · QTY · Quantity · Max >1 · Optional

                  To specify quantity information

               9. 450 · MSG · Message Text · Max >1 · Optional

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

               10. 460 · DMA · Additional Demographic Information · Max 1 · Optional

                   To supply additional demographic identification

               11. 470 · AM1 · Informational Values · Max 1 · Optional

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

               12. 480 · DMG · Demographic Information · Max 1 · Optional

                   To supply demographic information

               13. 490 · AMT · Monetary Amount · Max 1 · Optional

                   To indicate the total monetary amount

               14. 500 · EC · Employment Class · Max 1 · Optional

                   To provide class of employment information

               15. 510 · PER · Administrative Communications Contact · Max 1 · Optional

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

               16. 520 · REF · Reference Identification · Max 1 · Optional

                   To specify identifying information

               17. 530 · IN1 · Individual Identification · Max 1 · Optional

                   To provide identification of an individual or entity

               18. 540 · EMS · Employment Position · Max 1 · Optional

                   To describe employment position

               19. 550 · ASL · Asset Liability · Max >1 · Optional

                   To report financial information

               20. 560 · TOA · Type of Activity · Max 1 · Optional

                   To specify type of activity information

               21. 570 · TOV · Vehicle Use Information · Max 1 · Optional

                   To report usage of a vehicle

               22. 580 · III · Information · Max 1 · Optional

                   To report information

               23. 590 · SIN · Substance Use · Max 1 · Optional

                   To report use of tobacco, alcohol, drugs or other substances

               24. 600 · UCS · Underwriting Considerations · Max 1 · Optional

                   To report personal health and medical history data

               25. 610 · FH · Family History · Max 1 · Optional

                   To report information about a person's family health history

               26. 620 · UD · Underwriting Status · Max 1 · Optional

                   To identify and describe underwriting status of submitted applications

               27. 630 · CDS · Case Description · Max 1 · Optional

                   To identify and describe a specific court case

               28. 640 · CED · Court Event Description · Max 1 · Optional

                   To describe court events and actions in a specific court case

               29. 650 · YNQ · Yes/No Question · Max 1 · Optional

                   To identify and answer yes and no questions, including the date, time, and comments further qualifying the condition

               30. 660 · MPI · Military Personnel Information · Max 1 · Optional

                   To report military service data

               31. 2450 Loop Optional Repeat >1

                   1. 670 · EFI · Electronic Format Identification · Max 1 · Mandatory

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

                      The 2450 loop contains binary data of medical images such as heart chart, ECG, etc.

                   2. 680 · BIN · Binary Data · Max 1 · Mandatory

                      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

         8. 690 · LS · Loop Header · Max 1 · Optional

            To indicate that the next segment begins a loop

         9. 2500 Loop Optional Repeat >1

            1. 700 · UD · Underwriting Status · Max 1 · Mandatory

               To identify and describe underwriting status of submitted applications

               The bounded 2500 loop allows the signature(s) and identifying information for multiple people.
               The UD segment identifies the status of the signature if not included in this transaction.

            2. 710 · NM1 · Individual or Organizational Name · Max 1 · Optional

               To supply the full name of an individual or organizational entity

            3. 720 · N4 · Geographic Location · Max 1 · Optional

               To specify the geographic place of the named party

            4. 730 · REL · Relationship · Max 1 · Optional

               To specify relationship and birth order of entity

               The REL segment identifies the relationship between the signee and the proposed insured.

            5. 740 · DTP · Date or Time or Period · Max 1 · Optional

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

               The DTP segment indicates the date the signature was signed.

            6. 2550 Loop Optional Repeat >1

               1. 750 · EFI · Electronic Format Identification · Max 1 · Mandatory

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

                  The 2550 loop contains binary data representing a signature and identifying information.

               2. 760 · BIN · Binary Data · Max 1 · Mandatory

                  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

         10. 770 · LE · Loop Trailer · Max 1 · Optional

             To indicate that the loop immediately preceding this segment is complete

2. 780 · 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)