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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

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. NM1 Loop Optional
    Repeat 9
    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.
    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. ACT Loop Mandatory
    Repeat >1
    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.
    2. To specify a code and the amount or quantity or percentage associated with it

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

    4. To specify identifying information

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

    6. To specify pertinent dates and times

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

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

    9. 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. 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. To specify additional names

      3. LX Loop Mandatory
        Repeat >1
        1. To reference a line number in a transaction set

        2. To specify the location of the named party

        3. To specify the geographic place of the named party

        4. To indicate the action to be taken with the information provided or the status of the entity described

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

        6. To supply demographic information

        7. To provide additional demographic information to the receiving school, institution, or agency to assist in identifying the particular student

        8. To provide characteristics that may have multiple values

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

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

          The PO1 loop contains services requested to be performed by the information provider.
        2. To indicate the action to be taken with the information provided or the status of the entity described

        3. To supply additional demographic identification

        4. To specify identifying information

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

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

        7. To indicate that the next segment begins a loop

        8. LX Loop Optional
          Repeat >1
          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.
          2. To supply the full name of an individual or organizational entity

          3. To specify additional names

          4. To define types and values of a geographic location

          5. To specify the geographic place of the named party

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

          7. To provide additional demographic information to the receiving school, institution, or agency to assist in identifying the particular student

          8. To describe employment position

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

          10. To specify basic data about the contract or contract line item

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

          12. To provide characteristics that may have multiple values

          13. To specify identifying information

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

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

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

        9. To indicate that the loop immediately preceding this segment is complete

  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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