EDI 255 Underwriting Information Services

Functional Group UI

X12N Insurance Subcommittee

This X12 Transaction Set contains the format and establishes the data contents of the 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 underwriting process. In addition, the standard can be used between trading partners to request/receive status information on outstanding requests.

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 · CUR · Currency · Max 1 · Optional

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

4. NM1 Loop Optional Repeat 9

   1. 0400 · 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. 0500 · N3 · Party Location · Max 2 · Optional

      To specify the location of the named party

   3. 0600 · N4 · Geographic Location · Max 1 · Optional

      To specify the geographic place of the named party

   4. 0700 · REF · Reference Information · Max 9 · Optional

      To specify identifying information

   5. 0800 · 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. 0100 · 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. 0200 · AM1 · Informational Values · Max 9 · Optional

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

   3. 0300 · PWK · Paperwork · Max 1 · Optional

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

   4. 0400 · REF · Reference Information · 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 · DTM · Date/Time Reference · Max 9 · Optional

      To specify pertinent dates and times

   7. 0700 · MSG · Message Text · Max 9 · Optional

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

   8. 0750 · YNQ · Yes/No Question · Max 15 · Optional

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

   9. 0760 · NTE · Note/Special Instruction · Max >1 · Optional

      To transmit information in a free-form format, if necessary, for comment or special instruction

      The NTE segment is used to communicate specific underwriting instructions to the service provider.

   10. NM1 Loop Mandatory Repeat >1

       1. 0800 · 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 multiple proposed insureds within a policy number in one ACT loop.

       2. 0900 · N2 · Additional Name Information · Max 3 · Optional

          To specify additional names

       3. LX Loop Mandatory Repeat >1

          1. 0950 · LX · Transaction Set Line Number · Max 1 · Mandatory

             To reference a line number in a transaction set

          2. 1000 · N3 · Party Location · Max 3 · Optional

             To specify the location of the named party

          3. 1100 · N4 · Geographic Location · Max 1 · Optional

             To specify the geographic place of the named party

          4. 1200 · 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

          5. 1300 · PER · Administrative Communications Contact · Max 3 · Optional

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

          6. 1400 · DMG · Demographic Information · Max 1 · Optional

             To supply demographic information

          7. 1500 · 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

          8. 1600 · CD2 · Multi-Valued Characteristics · Max 9 · Optional

             To provide characteristics that may have multiple values

          9. 1700 · MSG · Message Text · Max 9 · Optional

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

       4. EFI Loop Optional Repeat >1

          1. 1800 · 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. 2000 · BIN · Binary Data Segment · 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

       5. PO1 Loop Optional Repeat >1

          1. 2100 · 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. 2200 · 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. 2300 · DMA · Additional Demographic Information · Max 9 · Optional

             To supply additional demographic identification

          4. 2400 · REF · Reference Information · Max 9 · Optional

             To specify identifying information

          5. 2500 · DTP · Date or Time or Period · Max 9 · Optional

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

          6. 2600 · MSG · Message Text · Max 9 · Optional

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

          7. 2650 · LS · Loop Header · Max 1 · Optional

             To indicate that the next segment begins a loop

          8. LX Loop Optional Repeat >1

             1. 2700 · LX · Transaction Set Line 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. 2800 · NM1 · Individual or Organizational Name · Max 1 · Mandatory

                To supply the full name of an individual or organizational entity

             3. 2900 · N2 · Additional Name Information · Max 3 · Optional

                To specify additional names

             4. 3000 · NX2 · Location ID Component · Max >1 · Optional

                To define types and values of a geographic location

             5. 3100 · N4 · Geographic Location · Max 1 · Optional

                To specify the geographic place of the named party

             6. 3150 · REC · Real Estate Condition · Max 1 · Optional

                To indicate the condition of real estate property and, if applicable, the actions needed to correct damage

             7. 3200 · 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

             8. 3300 · EMS · Employment Position · Max 1 · Optional

                To describe employment position

             9. 3400 · PER · Administrative Communications Contact · Max 3 · Optional

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

             10. 3500 · CN1 · Contract Information · Max 1 · Optional

                 To specify basic data about the contract or contract line item

             11. 3600 · DTP · Date or Time or Period · Max 9 · Optional

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

             12. 3700 · CD2 · Multi-Valued Characteristics · Max 9 · Optional

                 To provide characteristics that may have multiple values

             13. 3800 · REF · Reference Information · Max 9 · Optional

                 To specify identifying information

             14. 3900 · PWK · Paperwork · Max 1 · Optional

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

             15. 4000 · MSG · Message Text · Max 9 · Optional

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

             16. 4020 · AM1 · Informational Values · Max >1 · Optional

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

          9. 4050 · LE · Loop Trailer · Max 1 · Optional

             To indicate that the loop immediately preceding this segment is complete

2. 4100 · 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)