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.

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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. 1000 Loop Optional
    Repeat 2

    1. 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. To specify the location of the named party

    3. To specify the geographic place of the named party

    4. To specify identifying information

      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. 2000 Loop Mandatory
    Repeat >1

    1. To specify account information

      The 2000 loop occurs for each insurance company account, division, etc.
    2. 2050 Loop Mandatory
      Repeat >1

      1. 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. 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. To specify identifying information

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

        3. To specify the location of the named party

          The N3 segment applies to the individual applicant identified in the NM1 segment at 2/0300.

        4. To specify the geographic place of the named party

          The N4 segment applies to the individual applicant identified in the NM1 segment at 2/0300.

        5. To supply demographic information

          The DMG segment applies to the individual applicant identified in the NM1 segment at 2/0300.

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

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

        10. To supply additional demographic identification

          The DMA segment applies to the individual applicant identified in the NM1 segment at 2/0300.

        11. To specify quantity information

          The QTY segment applies to the individual applicant identified in the NM1 segment at 2/0300.
      3. 2100 Loop Mandatory
        Repeat >1

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

        3. 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. 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 1/0500.

          2. To specify identifying information

            The REF segment is repeated to capture multiple identification numbers for the entity identified in the NM1 at 2/1700.

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

          4. To specify the location of the named party

          5. To specify the geographic place of the named party

          6. To supply additional demographic identification

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

          7. 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. 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. 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 specify identifying information

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

          6. 2250 Loop Optional
            Repeat >1

            1. 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. To specify the geographic place of the named party

        6. 2300 Loop Optional
          Repeat >1

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

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

        7. 2350 Loop Optional
          Repeat >1

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

              The UQS segment allows information providers to send unique questions.

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

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

            5. To specify the location of the named party

            6. To specify the geographic place of the named party

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

            8. To specify quantity information

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

            10. To supply additional demographic identification

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

            12. To supply demographic information

            13. To indicate the total monetary amount

            14. To provide class of employment information

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

            16. To specify identifying information

            17. To provide identification of an individual or entity

            18. To describe employment position

            19. To report financial information

            20. To specify type of activity information

            21. To report usage of a vehicle

            22. To report information

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

            24. To report personal health and medical history data

            25. To report information about a person's family health history

            26. To identify and describe underwriting status of submitted applications

            27. To identify and describe a specific court case

            28. To describe specific administration of justice events and actions

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

            30. To report military service data

            31. 2450 Loop Optional
              Repeat >1

              1. 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. 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. To indicate that the next segment begins a loop

        9. 2500 Loop Optional
          Repeat >1

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

          3. To specify the geographic place of the named party

          4. To specify relationship and birth order of entity

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

          5. 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. 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. 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. To indicate that the loop immediately preceding this segment is complete

  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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