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Transaction Set
in
X12 Release 004010

186 Insurance Underwriting Requirements Reporting

Functional Group UW

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.

Heading

Sequence
Segment
Name
Max use
010
Transaction Set HeaderMandatory
Max 1
To indicate the start of a transaction set and to assign a control number
020
Beginning SegmentMandatory
Max 1
To indicate the beginning of a transaction set
030
Currency
Max 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.
040
Laboratory Test Results
Max 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
Repeat 2
050
Individual or Organizational Name
Max 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.
060
Address Information
Max 3
To specify the location of the named party
070
Geographic Location
Max 1
To specify the geographic place of the named party
080
Reference Identification
Max 9
To specify identifying information
The REF segment is used to convey regulatory licensing identification.
090
Administrative Communications Contact
Max 3
To identify a person or office to whom administrative communications should be directed

Detail

Sequence
Segment
Name
Max use
2000 Loop
Repeat >1
010
Account IdentificationMandatory
Max 1
To specify account information
The 2000 loop occurs for each insurance company account, division, etc.
2050 Loop
Repeat >1
020
Assigned NumberMandatory
Max 1
To reference a line number in a transaction set
The 2050 loop contains information about the proposed insured.
2075 Loop
Repeat >1
030
Individual or Organizational NameMandatory
Max 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.
040
Reference Identification
Max >1
To specify identifying information
The REF segment includes the insurance company's identification (application number, policy number, etc.).
050
Address Information
Max 1
To specify the location of the named party
The N3 segment applies to the individual applicant identified in the NM1 segment at 2/030.
060
Geographic Location
Max 1
To specify the geographic place of the named party
The N4 segment applies to the individual applicant identified in the NM1 segment at 2/030.
070
Demographic Information
Max 1
To supply demographic information
The DMG segment applies to the individual applicant identified in the NM1 segment at 2/030.
080
Date or Time or Period
Max 5
To specify any or all of a date, a time, or a time period
090
Informational Values
Max 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.
100
Paperwork
Max 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.
110
Message Text
Max >1
To provide a free-form format that allows the transmission of text information
120
Additional Demographic Information
Max 1
To supply additional demographic identification
The DMA segment applies to the individual applicant identified in the NM1 segment at 2/030.
130
Quantity
Max >1
To specify quantity information
The QTY segment applies to the individual applicant identified in the NM1 segment at 2/030.
2100 Loop
Repeat >1
140
Beginning of ReportMandatory
Max 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.
150
Date or Time or Period
Max >1
To specify any or all of a date, a time, or a time period
160
Message Text
Max >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
Repeat >1
170
Individual or Organizational Name
Max 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 1/050.
180
Reference Identification
Max >1
To specify identifying information
The REF segment is repeated to capture multiple identification numbers for the entity identified in the NM1 at 2/170.
190
Administrative Communications Contact
Max 1
To identify a person or office to whom administrative communications should be directed
200
Address Information
Max 1
To specify the location of the named party
210
Geographic Location
Max 1
To specify the geographic place of the named party
220
Additional Demographic Information
Max 1
To supply additional demographic identification
The DMA segment identifies the language spoken by the proposed insured.
230
Relationship
Max 1
To specify relationship and birth order of entity
The REL segment identifies the relationship between the proposed insured and interpreter.
2200 Loop
Repeat >1
240
Specimen Kit Information
Max 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.
250
Multi-Valued Characteristics
Max 9
To provide characteristics that may have multiple values
260
Date or Time or Period
Max 9
To specify any or all of a date, a time, or a time period
270
Reference Identification
Max 1
To specify identifying information
280
Message Text
Max >1
To provide a free-form format that allows the transmission of text information
2250 Loop
Repeat >1
290
Individual or Organizational Name
Max 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.
300
Geographic Location
Max 1
To specify the geographic place of the named party
2300 Loop
Repeat >1
310
Laboratory Test Results
Max 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.
320
Multi-Valued Characteristics
Max 9
To provide characteristics that may have multiple values
330
Date or Time or Period
Max 9
To specify any or all of a date, a time, or a time period
340
Individual or Organizational Name
Max 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.
350
Message Text
Max >1
To provide a free-form format that allows the transmission of text information
2350 Loop
Repeat >1
360
Underwriting Category
Max 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
Repeat >1
370
Hierarchical Level
Max 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.
380
Underwriting Question
Max 1
To report information provider underwriting data in a question and answer format
The UQS segment allows information providers to send unique questions.
390
Individual or Organizational Name
Max 1
To supply the full name of an individual or organizational entity
400
Name
Max 1
To identify a party by type of organization, name, and code
410
Address Information
Max 1
To specify the location of the named party
420
Geographic Location
Max 1
To specify the geographic place of the named party
430
Date or Time or Period
Max >1
To specify any or all of a date, a time, or a time period
440
Quantity
Max >1
To specify quantity information
450
Message Text
Max >1
To provide a free-form format that allows the transmission of text information
460
Additional Demographic Information
Max 1
To supply additional demographic identification
470
Informational Values
Max 1
To specify a code and the amount or quantity or percentage associated with it
480
Demographic Information
Max 1
To supply demographic information
490
Monetary Amount
Max 1
To indicate the total monetary amount
500
Employment Class
Max 1
To provide class of employment information
510
Administrative Communications Contact
Max 1
To identify a person or office to whom administrative communications should be directed
520
Reference Identification
Max 1
To specify identifying information
530
Individual Identification
Max 1
To provide identification of an individual or entity
540
Employment Position
Max 1
To describe employment position
550
Asset Liability
Max >1
To report financial information
560
Type of Activity
Max 1
To specify type of activity information
570
Vehicle Use Information
Max 1
To report usage of a vehicle
580
Information
Max >1
To report information
590
Substance Use
Max 1
To report use of tobacco, alcohol, drugs or other substances
600
Underwriting Considerations
Max 1
To report personal health and medical history data
610
Family History
Max 1
To report information about a person's family health history
620
Underwriting Status
Max 1
To identify and describe underwriting status of submitted applications
630
Case Description
Max 1
To identify and describe a specific court case
640
Administration of Justice Event Description
Max 1
To describe specific administration of justice events and actions
650
Yes/No Question
Max 1
To identify and answer yes and no questions, including the date, time, and comments further qualifying the condition
660
Military Personnel Information
Max 1
To report military service data
2450 Loop
Repeat >1
670
Electronic Format Identification
Max 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.
680
Binary DataMandatory
Max 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
690
Loop Header
Max 1
To indicate that the next segment begins a loop
2500 Loop
Repeat >1
700
Underwriting Status
Max 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.
710
Individual or Organizational Name
Max 1
To supply the full name of an individual or organizational entity
720
Geographic Location
Max 1
To specify the geographic place of the named party
730
Relationship
Max 1
To specify relationship and birth order of entity
The REL segment identifies the relationship between the signee and the proposed insured.
740
Date or Time or Period
Max 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
Repeat >1
750
Electronic Format Identification
Max 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.
760
Binary DataMandatory
Max 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
770
Loop Trailer
Max 1
To indicate that the loop immediately preceding this segment is complete
780
Transaction Set TrailerMandatory
Max 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)
Stedi is a registered trademark of Stedi, Inc. Stedi's EDI Reference and Mapping Guides are provided for marketing purposes and are free of charge. All names, logos, and brands of third parties listed on our site are trademarks of their respective owners (including “X12”, which is a trademark of X12 Incorporated). Stedi, Inc. and its products and services are not endorsed by, sponsored by, or affiliated with these third parties. Our use of these names, logos, and brands is for identification purposes only, and does not imply any such endorsement, sponsorship, or affiliation.
Stedi is a registered trademark of Stedi, Inc. Stedi's EDI Reference and Mapping Guides are provided for marketing purposes and are free of charge. All names, logos, and brands of third parties listed on our site are trademarks of their respective owners (including “X12”, which is a trademark of X12 Incorporated). Stedi, Inc. and its products and services are not endorsed by, sponsored by, or affiliated with these third parties. Our use of these names, logos, and brands is for identification purposes only, and does not imply any such endorsement, sponsorship, or affiliation.