148 - Report of Injury, Illness or Incident

FUNCTIONAL GROUP=IJ

This X12 Transaction Set contains the format and establishes the data contents of the Report of Injury, Illness or Incident Transaction Set (148) for use within the context of an Electronic Data Interchange (EDI) environment. The transaction set can be used to report information pertaining to an injury, illness or incident to entities interested in the information for statistical, legal, and claims and risk management processing requirements.

SCHEMA

ST

Segment	Name	Position
ST	Transaction Set Header	0100
BHT	Beginning of Hierarchical Transaction	0200
CUR	Currency	0220
QTY	Quantity Information	0240
REF	Reference Information	0260

NM1

Segment	Name	Position
NM1	Individual or Organizational Name	0300
N2	Additional Name Information	0400
N3	Party Location	0500
N4	Geographic Location	0600
PER	Administrative Communications Contact	0700
ACT	Account Identification	0800
DTP	Date or Time or Period	0900
DMG	Demographic Information	1000
REF	Reference Information	1100
QTY	Quantity Information	1200
CRC	Conditions Indicator	1300

HL

Segment	Name	Position
HL	Hierarchical Level	0100
CRI	Claim Report Information	0150
ACT	Account Identification	0200
DTP	Date or Time or Period	0300
CUR	Currency	0400
AMT	Monetary Amount Information	0500
FC	Financial Contribution	0600
REF	Reference Information	0700
DMG	Demographic Information	0800
QTY	Quantity Information	0900
CRC	Conditions Indicator	1200
VEH	Vehicle Information	1250

NM1

Segment	Name	Position
NM1	Individual or Organizational Name	1300
N2	Additional Name Information	1400
N3	Party Location	1500
N4	Geographic Location	1600
PER	Administrative Communications Contact	1700
ACT	Account Identification	1720
DTP	Date or Time or Period	1740
DMG	Demographic Information	1760
REF	Reference Information	1780
QTY	Quantity Information	1790
CRC	Conditions Indicator	1800

ESI

Segment	Name	Position
ESI	Employment Status Information	1830
EMT	Employment	1850
TPB	Business Professional Title	1870
DTP	Date or Time or Period	1900
REF	Reference Information	1930
QTY	Quantity Information	1950
NM1	Individual or Organizational Name	2000
PER	Administrative Communications Contact	2010
CRC	Conditions Indicator	2020

LX

Segment	Name	Position
LX	Transaction Set Line Number	2050
AIN	Income	2100
CUR	Currency	2200
TXI	Tax Information	2300
WS	Work Schedule	2400
DTP	Date or Time or Period	2500
QTY	Quantity Information	2600
REF	Reference Information	2650

LN

Segment	Name	Position
LN	Loan Information	2700
REF	Reference Information	2800

VEH

Segment	Name	Position
VEH	Vehicle Information	2820
N4	Geographic Location	2840
PID	Product/Item Description	2860

AMT

Segment	Name	Position
AMT	Monetary Amount Information	2900
PCT	Percent Amounts	2950
DTP	Date or Time or Period	3000

NM1

Segment	Name	Position
NM1	Individual or Organizational Name	3050
DMG	Demographic Information	3070
N3	Party Location	3090
N4	Geographic Location	3120
PER	Administrative Communications Contact	3140
DTP	Date or Time or Period	3160
REF	Reference Information	3180
LS	Loop Header	3190

LX

Segment	Name	Position
LX	Transaction Set Line Number	3200

III

Segment	Name	Position
III	Information	3250
IMP	Impairment Detail	3300
DTP	Date or Time or Period	3400
CRC	Conditions Indicator	3420
QTY	Quantity Information	3430
REF	Reference Information	3440

LM

Segment	Name	Position
LM	Code Source Information	3450
LQ	Industry Code Identification	3460

NM1

Segment	Name	Position
NM1	Individual or Organizational Name	3500
N2	Additional Name Information	3600
N3	Party Location	3700
N4	Geographic Location	3800
PER	Administrative Communications Contact	3900
ACT	Account Identification	3920
DTP	Date or Time or Period	3940
DMG	Demographic Information	3960
REF	Reference Information	3970
CRC	Conditions Indicator	3980
LE	Loop Trailer	3990

CFI

Segment	Name	Position
CFI	Compensation Financial Information	4000
CUR	Currency	4100
AMT	Monetary Amount Information	4150
DTP	Date or Time or Period	4200
QTY	Quantity Information	4300
REL	Relationship	4400
REF	Reference Information	4420
CRC	Conditions Indicator	4440

AD1

Segment	Name	Position
AD1	Adjustment Amount	4460
DTP	Date or Time or Period	4480
REF	Reference Information	4490

NM1

Segment	Name	Position
NM1	Individual or Organizational Name	4500
N2	Additional Name Information	4600
N3	Party Location	4700
N4	Geographic Location	4800
PER	Administrative Communications Contact	4900
ACT	Account Identification	4920
DTP	Date or Time or Period	4940
DMG	Demographic Information	4960
REF	Reference Information	4980

SE

Segment	Name	Position
GRI	Statistical Government Information	0100
SE	Transaction Set Trailer	0300

COMMENTS

Notes
1/0300	The NM1 loop is used to identify the submitter and receiver of the report.
2/0100	HL identifies the appropriate hierarchical level: Reporting Agency (RA), Claim Administrator (AB), Primary Claim Administrator (PA), Secondary Claim Administrator (SA), Insurer (AA), Insured (AC), Contract Holder (CH), Contract Holder Branch (CB), Claimant (CL), Cause of Injury (CI), Source of Injury (SI), Body Part (BP), Nature of Injury (NI), and Payment Detail (PY). All levels are optional.
2/1300	NM1 segment designates the names of the entities represented at that hierarchical level.
2/1830	The ESI segment identifies pre and post injury information, including income and work schedules.
2/2500	The time period applies to all income and work schedules specified within the loop.
2/2700	The LN segment is used primarily by Credit Insurance. Other business lines may also utilize this segment in determining coverage and claim processing.
2/3200	The LX loop allows III Loop at position 3250 or NM1 Loop at position 3500 to be used independently, or represent a "1 to 1", "1 to Many" or "Many to 1" relationship between their respective information.
2/3250	The III segment contains information about the accident or injury or illness or incident.
2/3450	The LM loop specifies the code(s) and code source(s) for Cause of Injury, Source of Injury, Body Part, and Nature of Illness, and or Diagnosis, Occupation Code, or similar coded data consistent with injury, illness, or incident reporting represented at the Claimant or other hierarchical level as appropriate.
2/3500	The NM1 Loop specifies medical provider, witness, supervisor, place of occurrence, third party, and other entities pertaining to Injury, Illness, or Incident detail.
2/4000	The CFI segment specifies benefit payment, recovery, and reserve information at that hierarchical level.
2/4400	The REL segment is used to identify beneficiaries' relationship to the benefit payments or legal benefit compensability and distribution decisions.
2/4460	The AD1 segment specifies benefit adjustments and offsets represented at that hierarchical level.
2/4500	The NM1 segment specifies information about the offset benefits provider, payee, or dependent.

rev 22/11/2024