EDI 186 Insurance Underwriting Requirements Reporting
Functional Group UW
X12N Insurance Subcommittee
This X12 Transaction Set 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
- 0100Transaction Set HeaderMandatoryMax 1
To indicate the start of a transaction set and to assign a control number
- 0200Beginning SegmentMandatoryMax 1
To indicate the beginning of a transaction set
- 0300CurrencyOptionalMax 1
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. - 0400Laboratory Test ResultsOptionalMax 99
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. - 1000 Loop OptionalRepeat 2
- 0500Individual or Organizational NameMandatoryMax 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. - 0600Address InformationOptionalMax 3
To specify the location of the named party
- 0700Geographic LocationOptionalMax 1
To specify the geographic place of the named party
- 0800Reference IdentificationOptionalMax 9
To specify identifying information
The REF segment is used to convey regulatory licensing identification. - 0900Administrative Communications ContactOptionalMax 3
To identify a person or office to whom administrative communications should be directed
- 0500Individual or Organizational NameMandatoryMax 1
Detail
- 2000 Loop MandatoryRepeat >1
- 0100Account IdentificationMandatoryMax 1
To specify account information
The 2000 loop occurs for each insurance company account, division, etc. - 2050 Loop MandatoryRepeat >1
- 0200Assigned NumberMandatoryMax 1
To reference a line number in a transaction set
The 2050 loop contains information about the proposed insured. - 2075 Loop MandatoryRepeat >1
- 0300Individual or Organizational NameMandatoryMax 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. - 0400Reference IdentificationOptionalMax >1
To specify identifying information
The REF segment includes the insurance company's identification (application number, policy number, etc.). - 0500Address InformationOptionalMax 1
To specify the location of the named party
The N3 segment applies to the individual applicant identified in the NM1 segment at 2/0300. - 0600Geographic LocationOptionalMax 1
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. - 0700Demographic InformationOptionalMax 1
To supply demographic information
The DMG segment applies to the individual applicant identified in the NM1 segment at 2/0300. - 0800Date or Time or PeriodOptionalMax 5
To specify any or all of a date, a time, or a time period
- 0900Informational ValuesOptionalMax 9
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. - 1000PaperworkOptionalMax 1
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. - 1100Message TextOptionalMax >1
To provide a free-form format that allows the transmission of text information
- 1200Additional Demographic InformationOptionalMax 1
To supply additional demographic identification
The DMA segment applies to the individual applicant identified in the NM1 segment at 2/0300. - 1300QuantityOptionalMax >1
To specify quantity information
The QTY segment applies to the individual applicant identified in the NM1 segment at 2/0300.
- 0300Individual or Organizational NameMandatoryMax 1
- 2100 Loop MandatoryRepeat >1
- 1400Beginning of ReportMandatoryMax 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. - 1500Date or Time or PeriodOptionalMax >1
To specify any or all of a date, a time, or a time period
- 1600Message TextOptionalMax >1
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. - 2150 Loop OptionalRepeat >1
- 1700Individual or Organizational NameMandatoryMax 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. - 1800Reference IdentificationOptionalMax >1
To specify identifying information
The REF segment is repeated to capture multiple identification numbers for the entity identified in the NM1 at 2/1700. - 1900Administrative Communications ContactOptionalMax 1
To identify a person or office to whom administrative communications should be directed
- 2000Address InformationOptionalMax 1
To specify the location of the named party
- 2100Geographic LocationOptionalMax 1
To specify the geographic place of the named party
- 2200Additional Demographic InformationOptionalMax 1
To supply additional demographic identification
The DMA segment identifies the language spoken by the proposed insured. - 2300RelationshipOptionalMax 1
To specify relationship and birth order of entity
The REL segment identifies the relationship between the proposed insured and interpreter.
- 1700Individual or Organizational NameMandatoryMax 1
- 2200 Loop OptionalRepeat >1
- 2400Specimen Kit InformationMandatoryMax 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. - 2500Multi-Valued CharacteristicsOptionalMax 9
To provide characteristics that may have multiple values
- 2600Date or Time or PeriodOptionalMax 9
To specify any or all of a date, a time, or a time period
- 2700Reference IdentificationOptionalMax 1
To specify identifying information
- 2800Message TextOptionalMax >1
To provide a free-form format that allows the transmission of text information
- 2250 Loop OptionalRepeat >1
- 2900Individual or Organizational NameMandatoryMax 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. - 3000Geographic LocationOptionalMax 1
To specify the geographic place of the named party
- 2900Individual or Organizational NameMandatoryMax 1
- 2400Specimen Kit InformationMandatoryMax 1
- 2300 Loop OptionalRepeat >1
- 3100Laboratory Test ResultsMandatoryMax 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. - 3200Multi-Valued CharacteristicsOptionalMax 9
To provide characteristics that may have multiple values
- 3300Date or Time or PeriodOptionalMax 9
To specify any or all of a date, a time, or a time period
- 3400Individual or Organizational NameOptionalMax 9
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. - 3500Message TextOptionalMax >1
To provide a free-form format that allows the transmission of text information
- 3100Laboratory Test ResultsMandatoryMax 1
- 2350 Loop OptionalRepeat >1
- 3600Underwriting CategoryMandatoryMax 1
To identify the category of underwriting data being transmitted
The 2350 loop categorizes the information being reported in this and subordinate loops. - 2400 Loop OptionalRepeat >1
- 3700Hierarchical LevelMandatoryMax 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. - 3800Underwriting QuestionOptionalMax 1
To report information provider underwriting data in a question and answer format
The UQS segment allows information providers to send unique questions. - 3900Individual or Organizational NameOptionalMax 1
To supply the full name of an individual or organizational entity
- 4000NameOptionalMax 1
To identify a party by type of organization, name, and code
- 4100Address InformationOptionalMax 1
To specify the location of the named party
- 4200Geographic LocationOptionalMax 1
To specify the geographic place of the named party
- 4300Date or Time or PeriodOptionalMax >1
To specify any or all of a date, a time, or a time period
- 4400QuantityOptionalMax >1
To specify quantity information
- 4500Message TextOptionalMax >1
To provide a free-form format that allows the transmission of text information
- 4600Additional Demographic InformationOptionalMax 1
To supply additional demographic identification
- 4700Informational ValuesOptionalMax 1
To specify a code and the amount or quantity or percentage associated with it
- 4800Demographic InformationOptionalMax 1
To supply demographic information
- 4900Monetary AmountOptionalMax 1
To indicate the total monetary amount
- 5000Employment ClassOptionalMax 1
To provide class of employment information
- 5100Administrative Communications ContactOptionalMax 1
To identify a person or office to whom administrative communications should be directed
- 5200Reference IdentificationOptionalMax 1
To specify identifying information
- 5300Individual IdentificationOptionalMax 1
To provide identification of an individual or entity
- 5400Employment PositionOptionalMax 1
To describe employment position
- 5500Asset LiabilityOptionalMax >1
To report financial information
- 5600Type of ActivityOptionalMax 1
To specify type of activity information
- 5700Vehicle Use InformationOptionalMax 1
To report usage of a vehicle
- 5800InformationOptionalMax >1
To report information
- 5900Substance UseOptionalMax 1
To report use of tobacco, alcohol, drugs or other substances
- 6000Underwriting ConsiderationsOptionalMax 1
To report personal health and medical history data
- 6100Family HistoryOptionalMax 1
To report information about a person's family health history
- 6200Underwriting StatusOptionalMax 1
To identify and describe underwriting status of submitted applications
- 6300Case DescriptionOptionalMax 1
To identify and describe a specific court case
- 6400Administration of Justice Event DescriptionOptionalMax 1
To describe specific administration of justice events and actions
- 6500Yes/No QuestionOptionalMax 1
To identify and answer yes and no questions, including the date, time, and comments further qualifying the condition
- 6600Military Personnel InformationOptionalMax 1
To report military service data
- 2450 Loop OptionalRepeat >1
- 6700Electronic Format IdentificationMandatoryMax 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. - 6800Binary DataMandatoryMax 1
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
- 6700Electronic Format IdentificationMandatoryMax 1
- 3700Hierarchical LevelMandatoryMax 1
- 3600Underwriting CategoryMandatoryMax 1
- 6900Loop HeaderOptionalMax 1
To indicate that the next segment begins a loop
- 2500 Loop OptionalRepeat >1
- 7000Underwriting StatusMandatoryMax 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. - 7100Individual or Organizational NameOptionalMax 1
To supply the full name of an individual or organizational entity
- 7200Geographic LocationOptionalMax 1
To specify the geographic place of the named party
- 7300RelationshipOptionalMax 1
To specify relationship and birth order of entity
The REL segment identifies the relationship between the signee and the proposed insured. - 7400Date or Time or PeriodOptionalMax 1
To specify any or all of a date, a time, or a time period
The DTP segment indicates the date the signature was signed. - 2550 Loop OptionalRepeat >1
- 7500Electronic Format IdentificationMandatoryMax 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. - 7600Binary DataMandatoryMax 1
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
- 7500Electronic Format IdentificationMandatoryMax 1
- 7000Underwriting StatusMandatoryMax 1
- 7700Loop TrailerOptionalMax 1
To indicate that the loop immediately preceding this segment is complete
- 1400Beginning of ReportMandatoryMax 1
- 0200Assigned NumberMandatoryMax 1
- 0100Account IdentificationMandatoryMax 1
- 7800Transaction Set TrailerMandatoryMax 1
To indicate the end of the transaction set and provide the count of the transmitted segments (including the beginning (ST) and ending (SE) segments)