187 Premium Audit Request and Return

Functional Group AE

X12N Insurance Subcommittee

This X12 Transaction Set contains the format and establishes the data contents of the Premium Audit Request and Return Transaction Set (187) for use within the context of an Electronic Data Interchange (EDI) environment. This transaction set can be used to communicate premium audit information between property and casualty insurers, and independent premium audit service providers. This information includes, but is not limited to: premium audit request information (i.e., type of audit being requested, policyholder name, business locations, class codes, estimated exposures, date of coverage, producing agency, endorsements); and completed audit information (i.e., actual classification codes and exposures, description of operations, sources of financial information, subcontractor exposures) for the auditable general liability, commercial automobile and worker's compensation lines of insurance.

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

  4. To specify identifying information

  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. 1000 Loop Optional
    Repeat >1
    1. To identify a party by type of organization, name, and code

    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 identifying information

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

Detail

Position
Segment
Name
Max use
  1. 2000 Loop Mandatory
    Repeat >1
    1. To identify dependencies among and the content of hierarchically related groups of data segments

      Valid codes for HL03 to define levels for this transaction set are given below: AA - Insurer 19 - Provider of Service 34 - Location Record 35 - Company/Corporation 36 - Operating Unit 64 - Employee 65 - Insurance Policy 66 - Vehicle SD - Support Document
      At least one occurrence each of the insurer level, company/corporation level, and insurance policy level is required. The insurer level and the company/corporation level will always be the first two hierarchical levels and must be in that (hierarchical) order. If the premium audit is documented by location, the insurance policy level will immediately follow the location record level. If the premium audit is documented by policy, the insurance policy level will immediately follow the company/corporation level or the operating unit level, whichever is the lower level to which the hierarchy extends.
      The operating unit level is optional and if used, must immediately follow the company/corporation level.
      The location record level is optional. If the premium audit is documented by location and the operating unit level is NOT used, the location record level will immediately follow the company/corporation level. If the operating unit level is used, the location record level will immediately follow that level. If the premium audit is documented by policy, the location record level will immediately follow the insurance policy level.
      The provider of service level, employee level, and vehicle level are all optional and are hierarchically equal. If the premium audit is documented by location, any of these levels (if used) would be a child of the insurance policy level and would immediately follow (in any order) the insurance policy level. If the premium audit is documented by policy any of these levels (if used) would be a child of and would immediately follow either the insurance policy level or the location record level, whichever is the lower level to which the hierarchy extends.
      The support document level is optional and when used, will always immediately follow the provider of service level.
    2. 2100 Loop Optional
      Repeat 1
      1. To reference a line number in a transaction set

        Loop 2100 is used (at HL35 or HL65) to encapsulate loop 2120 for the attachment of premium audit data in formats external to the transaction set (e.g., an electronic spreadsheet file). At HL66 it contains information on vehicles being audited.
      2. To provide descriptions that identify a specific vehicle

      3. Identifies attributes associated with a vehicle

      4. To provide dynamic information pertaining to a vehicle

      5. To specify service characteristic data

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

      7. To specify physical measurements or counts, including dimensions, tolerances, variances, and weights (See Figures Appendix for example of use of C001)

      8. To specify identifying information

      9. To indicate the total monetary amount

      10. To specify the characteristics of an adjustment

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

      12. To specify tax information

      13. 2110 Loop Optional
        Repeat >1
        1. To specify quantity information

        2. To specify service characteristic data

      14. 2120 Loop Optional
        Repeat 5
        1. To provide basic information about the electronic format of the interchange data

        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

    3. 2200 Loop Optional
      Repeat 1
      1. To supply the full name of an individual or organizational entity

        Loop 2200 contains information to identify the insurer (HLAA), the insured (HL35), the insured business (HL36), an insured location (HL34), an insurance policy (HL65), an employee (HL64), a subcontractor (HL19), or a vehicle garaging location (HL66).
      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 supply demographic information

      6. To supply additional demographic identification

      7. To specify physical measurements or counts, including dimensions, tolerances, variances, and weights (See Figures Appendix for example of use of C001)

      8. To define types and values of a geographic location

      9. To specify identifying information

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

    4. 2300 Loop Optional
      Repeat >1
      1. To report information

        Loop 2300 contains premium audit detail information related to the insured business records (HL36), an insured location (HL34), an insurance policy (HL65), split audits (HL65), officer compensation (HL65), endorsements (HL65), classification codes (HL65), premium modifications (HL65), audit notes information (HL65), an employee (HL64), a subcontractor, (Hl19) or subcontractor insurance coverage (HLSD).
      2. To specify service characteristic data

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

      4. To specify physical measurements or counts, including dimensions, tolerances, variances, and weights (See Figures Appendix for example of use of C001)

      5. To specify identifying information

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

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

      8. To indicate the total monetary amount

      9. To specify the characteristics of an adjustment

      10. To supply information on conditions

      11. To qualify percent amounts and supply percent amounts

      12. To provide a description of personal property

      13. To provide a description of real property

      14. To provide specifics on property or legal description; this segment provides for a simple legal description such as lot, block and subdivision

      15. 2310 Loop Mandatory
        Repeat >1
        1. To provide processible supplementary information

          Loop 2310 contains supporting detail by specified date for an insurance policy (HL65) or an employee (HL64).
        2. To specify physical measurements or counts, including dimensions, tolerances, variances, and weights (See Figures Appendix for example of use of C001)

        3. To specify identifying information

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

        5. To indicate the total monetary amount

        6. To specify the characteristics of an adjustment

      16. 2320 Loop Optional
        Repeat >1
        1. To specify quantity information

          Loop 2320 contains quantitative detail necessary to the audit of certain types of insurance policies (HL65).
        2. To specify service characteristic data

      17. 2330 Loop Optional
        Repeat >1
        1. Code to transmit standard industry codes

          Loop 2330 contains monetary or financial detail necessary to the audit of certain types of insurance policies (HL65).
        2. To indicate the total monetary amount

        3. To specify the characteristics of an adjustment

        4. To qualify percent amounts and supply percent amounts

      18. 2340 Loop Optional
        Repeat >1
        1. To supply the full name of an individual or organizational entity

          Loop 2340 contains information to identify the issuing insurer (HLAA), the insured business records location (HL36), the insured location records location (HL34), the producing agent (HL65), various state jurisdictions applicable to an insurance policy (HL65), or the insurance carrier for a subcontractor (HLSD).
        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 supply demographic information

        6. To supply additional demographic identification

        7. To define types and values of a geographic location

        8. To specify identifying information

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

      19. 2350 Loop Optional
        Repeat >1
        1. To specify allowances, charges, or services

          Loop 2350 contains information to document the premium auditor�s time and fee, either for audits to be billed by the policy (HL65) or those to be billed by location (HL34).
        2. To specify any or all of a date, a time, or a time period

        3. To specify identifying information

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

Summary

Position
Segment
Name
Max use
  1. To specify the total invoice discounts and amounts

  2. 3000 Loop Optional
    Repeat >1
    1. To specify allowances, charges, or services

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

    3. To specify identifying information

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

  3. 3100 Loop Optional
    Repeat >1
    1. To identify the specific monetary balances associated with a particular account

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

  4. 3200 Loop Optional
    Repeat >1
    1. To identify a party by type of organization, name, and code

    2. 3210 Loop Optional
      Repeat >1
      1. To identify the specific monetary balances associated with a particular account

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

    3. 3220 Loop Optional
      Repeat >1
      1. To specify allowances, charges, or services

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

      3. To specify identifying information

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

  5. 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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