New: Drop-in replacement for Change Healthcare APIs

EDI 100 Insurance Plan Description

Functional Group PG

X12N Insurance Subcommittee

This X12 Transaction Set contains the format and establishes the data contents of the Insurance Plan Description Transaction Set (100) for use within the context of an Electronic Data Interchange (EDI) environment. The transaction set is used to transmit life insurance, annuity, and disability insurance product availability and features, historical performance, investment options, distributions channels, and offering company information.

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 being used in the transaction set

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

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

      The NM1 loop provides information about the sending and receiving parties.
    2. To specify the location of the named party

    3. To specify the geographic place of the named party

    4. To specify identifying information

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

Detail

Position
Segment
Name
Max use
  1. N1 Loop Mandatory
    Repeat >1
    1. To identify a party by type of organization, name, and code

      The N1 loop repeats for each individual company.
    2. To specify additional names

    3. To specify the location of the named party

    4. To specify the geographic place of the named party

    5. To specify a communication contact number

    6. To report information

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

    8. PER Loop Optional
      Repeat >1
      1. To identify a person or office to whom administrative communications should be directed

      2. To specify the location of the named party

      3. To specify the geographic place of the named party

    9. PID Loop Optional
      Repeat >1
      1. To describe a product or process in coded or free-form format

        The PID loop repeats for each plan.
      2. To specify basic item identification data

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

      4. To supply the full name of an individual or organizational entity

      5. BLI Loop Optional
        Repeat >1
        1. To specify basic item data: item identification, quantity, and price

          The BLI loop is used to report plan service features.
        2. To specify any or all of a date, a time, or a time period

        3. To report information

        4. To indicate the total monetary amount

        5. To specify quantity information

        6. SI Loop Optional
          Repeat >1
          1. To specify service characteristic data

          2. To indicate the total monetary amount

          3. To specify quantity information

      6. AM1 Loop Optional
        Repeat >1
        1. To specify a code and the amount or quantity or percentage associated with it

          The AM1 loop describes plan rules.
        2. To provide a free-form format that allows the transmission of text information

      7. PO1 Loop Optional
        Repeat >1
        1. To specify basic and most frequently used line item data

          The PO1 loop describes investment funds applicable to the plan.
        2. To specify basic item identification data

        3. To indicate the details and status of a product or product activity

        4. To report information

      8. N4 Loop Optional
        Repeat >1
        1. To specify the geographic place of the named party

          The N4 loop describes state availability and exceptions for each plan.
        2. To indicate the details and status of a product or product activity

        3. AM1 Loop Optional
          Repeat >1
          1. To specify a code and the amount or quantity or percentage associated with it

            The AM1 loop is used to report state rule exceptions.
          2. To provide a free-form format that allows the transmission of text information

        4. PO1 Loop Optional
          Repeat >1
          1. To specify basic and most frequently used line item data

            The PO1 loop reports investment fund state exceptions.
          2. To indicate the details and status of a product or product activity

          3. To report 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)

Stedi is a registered trademark of Stedi, Inc. Stedi's EDI Reference is provided for marketing purposes and is 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.