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EDI 148 Report of Injury, Illness or Incident

Functional Group IJ

X12N Insurance Subcommittee

This Draft Standard for Trial Use contains the format and establishes the data contents of the Report of Injury, Illness or Incident Transaction Set (148) for use within the context of an Electronic Data Interchange (EDI) environment. The transaction set can be used to report information pertaining to an injury, illness or incident to entities interested in the information for statistical, legal, and claims and risk management processing requirements.

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

  4. To specify quantity information

  5. NM1 Loop Optional
    Repeat >1
    1. To supply the full name of an individual or organizational entity

      The NM1 loop is used to identify the submitter and receiver of the report.
    2. To specify additional names or those longer than 35 characters in length

    3. To specify the location of the named party

    4. To specify the geographic place of the named party

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

    6. To specify account information

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

    8. To supply demographic information

    9. To specify identifying information

Detail

Position
Segment
Name
Max use
  1. HL Loop Mandatory
    Repeat 999999
    1. To identify dependencies among and the content of hierarchically related groups of data segments

      HL identifies the appropriate hierarchical level: Reporting Agency (RA), Primary Administrator (PA), Secondary Administrator (SA), Contractholder (CH), Contractholder Branch Office (CB), Claimant (CL), Cause of Injury (CI), Source of Injury (SI), Body Part (BP), Nature of Injury (NI), and Payment Detail (PY). All levels are optional.
    2. To specify account information

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

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

    5. To indicate the total monetary amount

    6. To specify the financial contribution information

    7. To specify identifying information

    8. To supply demographic information

    9. To specify quantity information

    10. To specify information about the claim being reported

    11. To specify employment information

    12. To supply information on conditions

    13. To provide descriptions that identify a specific vehicle

    14. NM1 Loop Mandatory
      Repeat 999
      1. To supply the full name of an individual or organizational entity

        NM1 segment designates the names of the entities represented at that hierarchical level.
      2. To specify additional names or those longer than 35 characters in length

      3. To specify the location of the named party

      4. To specify the geographic place of the named party

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

      6. To specify account information

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

      8. To supply demographic information

      9. To specify identifying information

    15. ESI Loop Optional
      Repeat 99
      1. To specify status of employment

        The ESI segment identifies pre and post injury information, including income and work schedules.
      2. To specify any or all of a date, a time, or a time period

      3. To specify quantity information

      4. To supply information on conditions

      5. AIN Loop Optional
        Repeat 99
        1. To provide type and amount of income obtained

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

        3. To specify tax information

        4. To specify an individual's work schedule

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

          The time period applies to all income and work schedules specified within the loop.
        6. To specify quantity information

    16. LN Loop Optional
      Repeat 999
      1. To specify information about the loan

        The LN segment is used primarily by Credit Insurance. Other business lines may also utilize this segment in determining coverage and claim processing.
      2. To specify identifying information

      3. VEH Loop Optional
        Repeat >1
        1. To provide descriptions that identify a specific vehicle

        2. To specify the geographic place of the named party

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

      4. AMT Loop Optional
        Repeat 99
        1. To indicate the total monetary amount

        2. To qualify percent amounts and supply percent amounts

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

      5. NM1 Loop Optional
        Repeat >1
        1. To supply the full name of an individual or organizational entity

        2. To supply demographic information

        3. To specify the location of the named party

        4. To specify the geographic place of the named party

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

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

        7. To specify identifying information

    17. III Loop Optional
      Repeat >1
      1. To report information

        The III segment contains information about the accident or injury or illness or incident.
      2. To specify impairment to a body part

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

      4. To supply information on conditions

      5. LM Loop Optional
        Repeat >1
        1. To transmit standard code list identification information

          The LM loop specifies the code(s) and code source(s) for Cause of Injury, Source of Injury, Body Part, and Nature of Injury represented at that hierarchical level.
        2. Code to transmit standard industry codes

      6. NM1 Loop Optional
        Repeat 999
        1. To supply the full name of an individual or organizational entity

          The NM1 Loop specifies medical provider, witness, supervisor, place of occurrence, third party, and other entities pertaining to Injury, Illness, or Incident detail.
        2. To specify additional names or those longer than 35 characters in length

        3. To specify the location of the named party

        4. To specify the geographic place of the named party

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

        6. To specify account information

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

        8. To supply demographic information

        9. To specify identifying information

    18. AD1 Loop Optional
      Repeat 999
      1. To specify the characteristics of an adjustment

        The AD1 segment specifies benefit adjustments, payments, offset, recovery, and reserve information represented at that hierarchical level.
      2. To specify the currency (dollars, pounds, francs, etc.) used in a transaction

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

      4. To specify quantity information

      5. To specify relationship and birth order of entity

        The REL segment is used to identify beneficiaries' relationship to benefit payments and/or legal benefit compensability and distribution decisions.
      6. NM1 Loop Optional
        Repeat 999
        1. To supply the full name of an individual or organizational entity

          The NM1 segment specifies information about the offset benefits provider.
        2. To specify additional names or those longer than 35 characters in length

        3. To specify the location of the named party

        4. To specify the geographic place of the named party

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

        6. To specify account information

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

        8. To supply demographic information

        9. To specify identifying information

Summary

Position
Segment
Name
Max use
  1. LX Loop Optional
    Repeat 1
    1. To reference a line number in a transaction set

    2. To specify quantity information

  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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