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Transaction Set
in
X12 Release 004010

255 Underwriting Information Services

Functional Group UI

This Draft Standard for Trial Use 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

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
NM1 Loop
Repeat 9
040
Individual or Organizational Name
Max 1
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.
050
Address Information
Max 2
To specify the location of the named party
060
Geographic Location
Max 1
To specify the geographic place of the named party
070
Reference Identification
Max 9
To specify identifying information
080
Administrative Communications Contact
Max 3
To identify a person or office to whom administrative communications should be directed

Detail

Sequence
Segment
Name
Max use
ACT Loop
Repeat >1
010
Account IdentificationMandatory
Max 1
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.
020
Informational Values
Max 9
To specify a code and the amount or quantity or percentage associated with it
030
Paperwork
Max 1
To identify the type or transmission or both of paperwork or supporting information
040
Reference Identification
Max 9
To specify identifying information
050
Administrative Communications Contact
Max 3
To identify a person or office to whom administrative communications should be directed
060
Date/Time Reference
Max 9
To specify pertinent dates and times
070
Message Text
Max 9
To provide a free-form format that allows the transmission of text information
075
Yes/No Question
Max 15
To identify and answer yes and no questions, including the date, time, and comments further qualifying the condition
NM1 Loop
Repeat >1
080
Individual or Organizational NameMandatory
Max 1
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.
090
Additional Name Information
Max 3
To specify additional names or those longer than 35 characters in length
LX Loop
Repeat >1
095
Assigned NumberMandatory
Max 1
To reference a line number in a transaction set
100
Address Information
Max 3
To specify the location of the named party
110
Geographic Location
Max 1
To specify the geographic place of the named party
120
Action or Status Indicator
Max 1
To indicate the action to be taken with the information provided or the status of the entity described
130
Administrative Communications Contact
Max 3
To identify a person or office to whom administrative communications should be directed
140
Demographic Information
Max 1
To supply demographic information
150
Additional Individual Demographic Information
Max 1
To provide additional demographic information to the receiving school, institution, or agency to assist in identifying the particular student
160
Multi-Valued Characteristics
Max 9
To provide characteristics that may have multiple values
170
Message Text
Max 9
To provide a free-form format that allows the transmission of text information
EFI Loop
Repeat >1
180
Electronic Format Identification
Max 1
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.
200
Binary Data
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
PO1 Loop
Repeat >1
210
Baseline Item Data
Max 1
To specify basic and most frequently used line item data
The PO1 loop contains services requested to be performed by the information provider.
220
Action or Status Indicator
Max 1
To indicate the action to be taken with the information provided or the status of the entity described
230
Additional Demographic Information
Max 9
To supply additional demographic identification
240
Reference Identification
Max 9
To specify identifying information
250
Date or Time or Period
Max 9
To specify any or all of a date, a time, or a time period
260
Message Text
Max 9
To provide a free-form format that allows the transmission of text information
265
Loop Header
Max 1
To indicate that the next segment begins a loop
LX Loop
Repeat >1
270
Assigned Number
Max 1
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.
280
Individual or Organizational NameMandatory
Max 1
To supply the full name of an individual or organizational entity
290
Additional Name Information
Max 3
To specify additional names or those longer than 35 characters in length
300
Location ID Component
Max >1
To define types and values of a geographic location
310
Geographic Location
Max 1
To specify the geographic place of the named party
315
Real Estate Condition
Max 1
To indicate the condition of real estate property and, if applicable, the actions needed to correct damage
320
Additional Individual Demographic Information
Max 1
To provide additional demographic information to the receiving school, institution, or agency to assist in identifying the particular student
330
Employment Position
Max 1
To describe employment position
340
Administrative Communications Contact
Max 3
To identify a person or office to whom administrative communications should be directed
350
Contract Information
Max 1
To specify basic data about the contract or contract line item
360
Date or Time or Period
Max 9
To specify any or all of a date, a time, or a time period
370
Multi-Valued Characteristics
Max 9
To provide characteristics that may have multiple values
380
Reference Identification
Max 9
To specify identifying information
390
Paperwork
Max 1
To identify the type or transmission or both of paperwork or supporting information
400
Message Text
Max 9
To provide a free-form format that allows the transmission of text information
402
Informational Values
Max >1
To specify a code and the amount or quantity or percentage associated with it
405
Loop Trailer
Max 1
To indicate that the loop immediately preceding this segment is complete
410
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.