EDI 187 Premium Audit Request and Return

Functional Group AE

X12N Insurance Subcommittee

This Draft Standard for Trial Use contains the format and establishes the data contents of the Premium Audit Request and Return Transaction Set (187) for use within the context of an Electronic Data Interchange (EDI) environment. This transaction set can be used to communicate premium audit information between property and casualty insurers, and independent premium audit service providers. This information includes, but is not limited to: premium audit request information (i.e., type of audit being requested, policyholder name, business locations, class codes, estimated exposures, date of coverage, producing agency, endorsements); and completed audit information (i.e., actual classification codes and exposures, description of operations, sources of financial information, subcontractor exposures) for the auditable general liability, commercial automobile and worker's compensation lines of insurance.

Heading

1. 0100 · ST · Transaction Set Header · Max 1 · Mandatory

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

2. 0200 · BGN · Beginning Segment · Max 1 · Mandatory

   To indicate the beginning of a transaction set

3. 0300 · MSG · Message Text · Max >1 · Optional

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

4. 0400 · REF · Reference Identification · Max >1 · Optional

   To specify identifying information

5. 0500 · PER · Administrative Communications Contact · Max 3 · Optional

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

6. 0600 · DTP · Date or Time or Period · Max 10 · Optional

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

7. 1000 Loop Optional Repeat >1

   1. 0700 · N1 · Name · Max 1 · Mandatory

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

   2. 0800 · N2 · Additional Name Information · Max 2 · Optional

      To specify additional names

   3. 0900 · N3 · Address Information · Max 2 · Optional

      To specify the location of the named party

   4. 1000 · N4 · Geographic Location · Max 1 · Optional

      To specify the geographic place of the named party

   5. 1100 · REF · Reference Identification · Max 12 · Optional

      To specify identifying information

   6. 1200 · 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. 0100 · HL · Hierarchical Level · Max 1 · Mandatory

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

      Valid codes for HL03 to define levels for this transaction set are given below: AA - Insurer 19 - Provider of Service 34 - Location Record 35 - Company/Corporation 36 - Operating Unit 64 - Employee 65 - Insurance Policy 66 - Vehicle SD - Support Document
      At least one occurrence each of the insurer level, company/corporation level, and insurance policy level is required. The insurer level and the company/corporation level will always be the first two hierarchical levels and must be in that (hierarchical) order. If the premium audit is documented by location, the insurance policy level will immediately follow the location record level. If the premium audit is documented by policy, the insurance policy level will immediately follow the company/corporation level or the operating unit level, whichever is the lower level to which the hierarchy extends.
      The operating unit level is optional and if used, must immediately follow the company/corporation level.
      The location record level is optional. If the premium audit is documented by location and the operating unit level is NOT used, the location record level will immediately follow the company/corporation level. If the operating unit level is used, the location record level will immediately follow that level. If the premium audit is documented by policy, the location record level will immediately follow the insurance policy level.
      The provider of service level, employee level, and vehicle level are all optional and are hierarchically equal. If the premium audit is documented by location, any of these levels (if used) would be a child of the insurance policy level and would immediately follow (in any order) the insurance policy level. If the premium audit is documented by policy any of these levels (if used) would be a child of and would immediately follow either the insurance policy level or the location record level, whichever is the lower level to which the hierarchy extends.
      The support document level is optional and when used, will always immediately follow the provider of service level.

   2. 2100 Loop Optional Repeat 1

      1. 0200 · LX · Assigned Number · Max 1 · Mandatory

         To reference a line number in a transaction set

         Loop 2100 is used (at HL35 or HL65) to encapsulate loop 2120 for the attachment of premium audit data in formats external to the transaction set (e.g., an electronic spreadsheet file). At HL66 it contains information on vehicles being audited.

      2. 0300 · VEH · Vehicle Information · Max 1 · Optional

         To provide descriptions that identify a specific vehicle

      3. 0400 · VAT · Vehicle Attribute · Max 20 · Optional

         Identifies attributes associated with a vehicle

      4. 0500 · DVI · Dynamic Vehicle Information · Max 1 · Optional

         To provide dynamic information pertaining to a vehicle

      5. 0600 · SI · Service Characteristic Identification · Max 8 · Optional

         To specify service characteristic data

      6. 0700 · PID · Product/Item Description · Max 10 · Optional

         To describe a product or process in coded or free-form format

      7. 0800 · MEA · Measurements · Max 10 · Optional

         To specify physical measurements or counts, including dimensions, tolerances, variances, and weights (See Figures Appendix for example of use of C001)

      8. 0900 · REF · Reference Identification · Max >1 · Optional

         To specify identifying information

      9. 1000 · AMT · Monetary Amount · Max 5 · Optional

         To indicate the total monetary amount

      10. 1100 · AD1 · Adjustment Amount · Max 20 · Optional

          To specify the characteristics of an adjustment

      11. 1200 · DTP · Date or Time or Period · Max 20 · Optional

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

      12. 1300 · TXI · Tax Information · Max >1 · Optional

          To specify tax information

      13. 2110 Loop Optional Repeat >1

          1. 1400 · QTY · Quantity · Max 1 · Mandatory

             To specify quantity information

          2. 1500 · SI · Service Characteristic Identification · Max 1 · Optional

             To specify service characteristic data

      14. 2120 Loop Optional Repeat 5

          1. 1600 · EFI · Electronic Format Identification · Max 1 · Mandatory

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

          2. 1700 · 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

   3. 2200 Loop Optional Repeat 1

      1. 1800 · NM1 · Individual or Organizational Name · Max 1 · Mandatory

         To supply the full name of an individual or organizational entity

         Loop 2200 contains information to identify the insurer (HLAA), the insured (HL35), the insured business (HL36), an insured location (HL34), an insurance policy (HL65), an employee (HL64), a subcontractor (HL19), or a vehicle garaging location (HL66).

      2. 1900 · N2 · Additional Name Information · Max 2 · Optional

         To specify additional names

      3. 2000 · N3 · Address Information · Max 2 · Optional

         To specify the location of the named party

      4. 2100 · N4 · Geographic Location · Max 1 · Optional

         To specify the geographic place of the named party

      5. 2200 · DMG · Demographic Information · Max 1 · Optional

         To supply demographic information

      6. 2300 · DMA · Additional Demographic Information · Max 1 · Optional

         To supply additional demographic identification

      7. 2400 · MEA · Measurements · Max 10 · Optional

         To specify physical measurements or counts, including dimensions, tolerances, variances, and weights (See Figures Appendix for example of use of C001)

      8. 2500 · NX2 · Location ID Component · Max 1 · Optional

         To define types and values of a geographic location

      9. 2600 · REF · Reference Identification · Max 10 · Optional

         To specify identifying information

      10. 2700 · PER · Administrative Communications Contact · Max >1 · Optional

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

   4. 2300 Loop Optional Repeat >1

      1. 2800 · III · Information · Max 1 · Mandatory

         To report information

         Loop 2300 contains premium audit detail information related to the insured business records (HL36), an insured location (HL34), an insurance policy (HL65), split audits (HL65), officer compensation (HL65), endorsements (HL65), classification codes (HL65), premium modifications (HL65), audit notes information (HL65), an employee (HL64), a subcontractor, (Hl19) or subcontractor insurance coverage (HLSD).

      2. 2900 · SI · Service Characteristic Identification · Max 2 · Optional

         To specify service characteristic data

      3. 3000 · PID · Product/Item Description · Max 10 · Optional

         To describe a product or process in coded or free-form format

      4. 3100 · MEA · Measurements · Max 10 · Optional

         To specify physical measurements or counts, including dimensions, tolerances, variances, and weights (See Figures Appendix for example of use of C001)

      5. 3200 · REF · Reference Identification · Max >1 · Optional

         To specify identifying information

      6. 3300 · DTP · Date or Time or Period · Max 10 · Optional

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

      7. 3400 · MSG · Message Text · Max >1 · Optional

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

      8. 3500 · AMT · Monetary Amount · Max 10 · Optional

         To indicate the total monetary amount

      9. 3600 · AD1 · Adjustment Amount · Max 20 · Optional

         To specify the characteristics of an adjustment

      10. 3700 · CRC · Conditions Indicator · Max 50 · Optional

          To supply information on conditions

      11. 3800 · PCT · Percent Amounts · Max 10 · Optional

          To qualify percent amounts and supply percent amounts

      12. 3900 · PDP · Property Description - Personal · Max >1 · Optional

          To provide a description of personal property

      13. 4000 · PDR · Property Description - Real · Max >1 · Optional

          To provide a description of real property

      14. 4100 · PDS · Property Description/Legal Description · Max >1 · Optional

          To provide specifics on property or legal description; this segment provides for a simple legal description such as lot, block and subdivision

      15. 2310 Loop Mandatory Repeat >1

          1. 4200 · SUP · Supplementary Information · Max 1 · Mandatory

             To provide processible supplementary information

             Loop 2310 contains supporting detail by specified date for an insurance policy (HL65) or an employee (HL64).

          2. 4300 · MEA · Measurements · Max 1 · Optional

             To specify physical measurements or counts, including dimensions, tolerances, variances, and weights (See Figures Appendix for example of use of C001)

          3. 4400 · REF · Reference Identification · Max >1 · Optional

             To specify identifying information

          4. 4500 · DTP · Date or Time or Period · Max >1 · Optional

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

          5. 4600 · AMT · Monetary Amount · Max >1 · Optional

             To indicate the total monetary amount

          6. 4700 · AD1 · Adjustment Amount · Max >1 · Optional

             To specify the characteristics of an adjustment

      16. 2320 Loop Optional Repeat >1

          1. 4800 · QTY · Quantity · Max 1 · Mandatory

             To specify quantity information

             Loop 2320 contains quantitative detail necessary to the audit of certain types of insurance policies (HL65).

          2. 4900 · SI · Service Characteristic Identification · Max 1 · Optional

             To specify service characteristic data

      17. 2330 Loop Optional Repeat >1

          1. 5000 · LQ · Industry Code · Max 1 · Mandatory

             Code to transmit standard industry codes

             Loop 2330 contains monetary or financial detail necessary to the audit of certain types of insurance policies (HL65).

          2. 5100 · AMT · Monetary Amount · Max 10 · Optional

             To indicate the total monetary amount

          3. 5200 · AD1 · Adjustment Amount · Max 10 · Optional

             To specify the characteristics of an adjustment

          4. 5300 · PCT · Percent Amounts · Max 10 · Optional

             To qualify percent amounts and supply percent amounts

      18. 2340 Loop Optional Repeat >1

          1. 5400 · NM1 · Individual or Organizational Name · Max 1 · Mandatory

             To supply the full name of an individual or organizational entity

             Loop 2340 contains information to identify the issuing insurer (HLAA), the insured business records location (HL36), the insured location records location (HL34), the producing agent (HL65), various state jurisdictions applicable to an insurance policy (HL65), or the insurance carrier for a subcontractor (HLSD).

          2. 5500 · N2 · Additional Name Information · Max 2 · Optional

             To specify additional names

          3. 5600 · N3 · Address Information · Max 2 · Optional

             To specify the location of the named party

          4. 5700 · N4 · Geographic Location · Max 1 · Optional

             To specify the geographic place of the named party

          5. 5800 · DMG · Demographic Information · Max 1 · Optional

             To supply demographic information

          6. 5900 · DMA · Additional Demographic Information · Max 1 · Optional

             To supply additional demographic identification

          7. 6000 · NX2 · Location ID Component · Max 1 · Optional

             To define types and values of a geographic location

          8. 6100 · REF · Reference Identification · Max >1 · Optional

             To specify identifying information

          9. 6200 · PER · Administrative Communications Contact · Max >1 · Optional

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

      19. 2350 Loop Optional Repeat >1

          1. 6300 · ITA · Allowance, Charge or Service · Max 1 · Mandatory

             To specify allowances, charges, or services

             Loop 2350 contains information to document the premium auditor's time and fee, either for audits to be billed by the policy (HL65) or those to be billed by location (HL34).

          2. 6400 · DTP · Date or Time or Period · Max >1 · Optional

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

          3. 6500 · REF · Reference Identification · Max 5 · Optional

             To specify identifying information

          4. 6600 · CUR · Currency · Max 1 · Optional

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

Summary

1. 0100 · TDS · Total Monetary Value Summary · Max 1 · Mandatory

   To specify the total invoice discounts and amounts

2. 3000 Loop Optional Repeat >1

   1. 0200 · ITA · Allowance, Charge or Service · Max 1 · Mandatory

      To specify allowances, charges, or services

   2. 0300 · DTP · Date or Time or Period · Max >1 · Optional

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

   3. 0400 · REF · Reference Identification · Max >1 · Optional

      To specify identifying information

   4. 0500 · CUR · Currency · Max 1 · Optional

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

3. 3100 Loop Optional Repeat >1

   1. 0600 · BAL · Balance Detail · Max 1 · Mandatory

      To identify the specific monetary balances associated with a particular account

   2. 0700 · DTP · Date or Time or Period · Max >1 · Optional

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

4. 3200 Loop Optional Repeat >1

   1. 0800 · N1 · Name · Max 1 · Mandatory

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

   2. 3210 Loop Optional Repeat >1

      1. 0900 · BAL · Balance Detail · Max 1 · Mandatory

         To identify the specific monetary balances associated with a particular account

      2. 1000 · DTP · Date or Time or Period · Max >1 · Optional

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

   3. 3220 Loop Optional Repeat >1

      1. 1100 · ITA · Allowance, Charge or Service · Max 1 · Mandatory

         To specify allowances, charges, or services

      2. 1200 · DTP · Date or Time or Period · Max >1 · Optional

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

      3. 1300 · REF · Reference Identification · Max >1 · Optional

         To specify identifying information

      4. 1400 · CUR · Currency · Max 1 · Optional

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

5. 1500 · 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)