186 Insurance Underwriting Requirements Reporting

Functional Group UW

X12N Insurance Subcommittee

This X12 Transaction Set 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

Position
Segment
Name
Max use
0100
Transaction Set HeaderMandatory
Max 1
To indicate the start of a transaction set and to assign a control number
0200
Beginning SegmentMandatory
Max 1
To indicate the beginning of a transaction set
0300
CurrencyOptional
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.
0400
Laboratory Test ResultsOptional
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
0500
Individual or Organizational NameMandatory
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.
0600
Party LocationOptional
Max 3
To specify the location of the named party
0700
Geographic LocationOptional
Max 1
To specify the geographic place of the named party
0800
Reference InformationOptional
Max 9
To specify identifying information
The REF segment is used to convey regulatory licensing identification.
0900
Administrative Communications ContactOptional
Max 3
To identify a person or office to whom administrative communications should be directed

Detail

Position
Segment
Name
Max use
2000 Loop
Repeat >1
0100
Account IdentificationMandatory
Max 1
To specify account information
The 2000 loop occurs for each insurance company account, division, etc.
2050 Loop
Repeat >1
0200
Transaction Set Line 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
0300
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.
0400
Reference InformationOptional
Max >1
To specify identifying information
The REF segment includes the insurance company's identification (application number, policy number, etc.).
0500
Party LocationOptional
Max 1
To specify the location of the named party
The N3 segment applies to the individual applicant identified in the NM1 segment at 2/0300.
0600
Geographic LocationOptional
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 2/0300.
0700
Demographic InformationOptional
Max 1
To supply demographic information
The DMG segment applies to the individual applicant identified in the NM1 segment at 2/0300.
0800
Date or Time or PeriodOptional
Max 5
To specify any or all of a date, a time, or a time period
0900
Informational ValuesOptional
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.
1000
PaperworkOptional
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.
1100
Message TextOptional
Max >1
To provide a free-form format that allows the transmission of text information
1200
Additional Demographic InformationOptional
Max 1
To supply additional demographic identification
The DMA segment applies to the individual applicant identified in the NM1 segment at 2/0300.
1300
Quantity InformationOptional
Max >1
To specify quantity information
The QTY segment applies to the individual applicant identified in the NM1 segment at 2/0300.
2100 Loop
Repeat >1
1400
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.
1500
Date or Time or PeriodOptional
Max >1
To specify any or all of a date, a time, or a time period
1600
Message TextOptional
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
1700
Individual or Organizational NameMandatory
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 1/0500.
1800
Reference InformationOptional
Max >1
To specify identifying information
The REF segment is repeated to capture multiple identification numbers for the entity identified in the NM1 at 2/1700.
1900
Administrative Communications ContactOptional
Max 1
To identify a person or office to whom administrative communications should be directed
2000
Party LocationOptional
Max 1
To specify the location of the named party
2100
Geographic LocationOptional
Max 1
To specify the geographic place of the named party
2200
Additional Demographic InformationOptional
Max 1
To supply additional demographic identification
The DMA segment identifies the language spoken by the proposed insured.
2300
RelationshipOptional
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
2400
Specimen Kit InformationMandatory
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.
2500
Multi-Valued CharacteristicsOptional
Max 9
To provide characteristics that may have multiple values
2600
Date or Time or PeriodOptional
Max 9
To specify any or all of a date, a time, or a time period
2700
Reference InformationOptional
Max 1
To specify identifying information
2800
Message TextOptional
Max >1
To provide a free-form format that allows the transmission of text information
2250 Loop
Repeat >1
2900
Individual or Organizational NameMandatory
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.
3000
Geographic LocationOptional
Max 1
To specify the geographic place of the named party
2300 Loop
Repeat >1
3100
Laboratory Test ResultsMandatory
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.
3200
Multi-Valued CharacteristicsOptional
Max 9
To provide characteristics that may have multiple values
3300
Date or Time or PeriodOptional
Max 9
To specify any or all of a date, a time, or a time period
3400
Individual or Organizational NameOptional
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.
3500
Message TextOptional
Max >1
To provide a free-form format that allows the transmission of text information
2350 Loop
Repeat >1
3600
Underwriting CategoryMandatory
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
3700
Hierarchical LevelMandatory
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.
3800
Underwriting QuestionOptional
Max 1
To report information provider underwriting data in a question and answer format
The UQS segment allows information providers to send unique questions.
3900
Individual or Organizational NameOptional
Max 1
To supply the full name of an individual or organizational entity
4000
Party IdentificationOptional
Max 1
To identify a party by type of organization, name, and code
4100
Party LocationOptional
Max 1
To specify the location of the named party
4200
Geographic LocationOptional
Max 1
To specify the geographic place of the named party
4300
Date or Time or PeriodOptional
Max >1
To specify any or all of a date, a time, or a time period
4400
Quantity InformationOptional
Max >1
To specify quantity information
4500
Message TextOptional
Max >1
To provide a free-form format that allows the transmission of text information
4600
Additional Demographic InformationOptional
Max 1
To supply additional demographic identification
4700
Informational ValuesOptional
Max 1
To specify a code and the amount or quantity or percentage associated with it
4800
Demographic InformationOptional
Max 1
To supply demographic information
4900
Monetary Amount InformationOptional
Max 1
To indicate the total monetary amount
5000
Employment ClassOptional
Max 1
To provide class of employment information
5100
Administrative Communications ContactOptional
Max 1
To identify a person or office to whom administrative communications should be directed
5200
Reference InformationOptional
Max 1
To specify identifying information
5300
Individual IdentificationOptional
Max 1
To provide identification of an individual or entity
5400
Employment PositionOptional
Max 1
To describe employment position
5500
Asset LiabilityOptional
Max >1
To report financial information
5600
Type of ActivityOptional
Max 1
To specify type of activity information
5900
Substance UseOptional
Max 1
To report use of tobacco, alcohol, drugs or other substances
6000
Underwriting ConsiderationsOptional
Max 1
To report personal health and medical history data
6100
Family HistoryOptional
Max 1
To report information about a person's family health history
6200
Underwriting StatusOptional
Max 1
To identify and describe underwriting status of submitted applications
6300
Case DescriptionOptional
Max 1
To identify and describe a specific court case
6400
Administration of Justice Event DescriptionOptional
Max 1
To describe specific administration of justice events and actions
6500
Yes/No QuestionOptional
Max 1
To identify and answer yes and no questions, including the date, time, and comments further qualifying the condition
2450 Loop
Repeat >1
6700
Electronic Format IdentificationMandatory
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.
6800
Binary Data SegmentMandatory
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
6900
Loop HeaderOptional
Max 1
To indicate that the next segment begins a loop
2500 Loop
Repeat >1
7000
Underwriting StatusMandatory
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.
7100
Individual or Organizational NameOptional
Max 1
To supply the full name of an individual or organizational entity
7200
Geographic LocationOptional
Max 1
To specify the geographic place of the named party
7300
RelationshipOptional
Max 1
To specify relationship and birth order of entity
The REL segment identifies the relationship between the signee and the proposed insured.
7400
Date or Time or PeriodOptional
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
7500
Electronic Format IdentificationMandatory
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.
7600
Binary Data SegmentMandatory
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
7700
Loop TrailerOptional
Max 1
To indicate that the loop immediately preceding this segment is complete
7800
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)

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