186 - Insurance Underwriting Requirements Reporting

FUNCTIONAL GROUP=UW

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.

SCHEMA

ST

Segment	Name	Position
ST	Transaction Set Header	0100
BGN	Beginning Segment	0200
CUR	Currency	0300
LTR	Laboratory Test Results	0400

1000

Segment	Name	Position
NM1	Individual or Organizational Name	0500
N3	Party Location	0600
N4	Geographic Location	0700
REF	Reference Information	0800
PER	Administrative Communications Contact	0900

2000

Segment	Name	Position
ACT	Account Identification	0100

2050

Segment	Name	Position
LX	Transaction Set Line Number	0200

2075

Segment	Name	Position
NM1	Individual or Organizational Name	0300
REF	Reference Information	0400
N3	Party Location	0500
N4	Geographic Location	0600
DMG	Demographic Information	0700
DTP	Date or Time or Period	0800
AM1	Informational Values	0900
PWK	Paperwork	1000
MSG	Message Text	1100
DMA	Additional Demographic Information	1200
QTY	Quantity Information	1300

2100

Segment	Name	Position
BOR	Beginning of Report	1400
DTP	Date or Time or Period	1500
MSG	Message Text	1600

2150

Segment	Name	Position
NM1	Individual or Organizational Name	1700
REF	Reference Information	1800
PER	Administrative Communications Contact	1900
N3	Party Location	2000
N4	Geographic Location	2100
DMA	Additional Demographic Information	2200
REL	Relationship	2300

2200

Segment	Name	Position
SPK	Specimen Kit Information	2400
CD2	Multi-Valued Characteristics	2500
DTP	Date or Time or Period	2600
REF	Reference Information	2700
MSG	Message Text	2800

2250

Segment	Name	Position
NM1	Individual or Organizational Name	2900
N4	Geographic Location	3000

2300

Segment	Name	Position
LTR	Laboratory Test Results	3100
CD2	Multi-Valued Characteristics	3200
DTP	Date or Time or Period	3300
NM1	Individual or Organizational Name	3400
MSG	Message Text	3500

2350

Segment	Name	Position
UC	Underwriting Category	3600

2400

Segment	Name	Position
HL	Hierarchical Level	3700
UQS	Underwriting Question	3800
NM1	Individual or Organizational Name	3900
N1	Party Identification	4000
N3	Party Location	4100
N4	Geographic Location	4200
DTP	Date or Time or Period	4300
QTY	Quantity Information	4400
MSG	Message Text	4500
DMA	Additional Demographic Information	4600
AM1	Informational Values	4700
DMG	Demographic Information	4800
AMT	Monetary Amount Information	4900
EC	Employment Class	5000
PER	Administrative Communications Contact	5100
REF	Reference Information	5200
IN1	Individual Identification	5300
EMS	Employment Position	5400
ASL	Asset Liability	5500
TOA	Type of Activity	5600
TOV	Vehicle Use Information	5700
III	Information	5800
SIN	Substance Use	5900
UCS	Underwriting Considerations	6000
FH	Family History	6100
UD	Underwriting Status	6200
CDS	Case Description	6300
CED	Administration of Justice Event Description	6400
YNQ	Yes/No Question	6500
MPI	Military Personnel Information	6600

2450

Segment	Name	Position
EFI	Electronic Format Identification	6700
BIN	Binary Data Segment	6800
LS	Loop Header	6900

2500

Segment	Name	Position
UD	Underwriting Status	7000
NM1	Individual or Organizational Name	7100
N4	Geographic Location	7200
REL	Relationship	7300
DTP	Date or Time or Period	7400

2550

Segment	Name	Position
EFI	Electronic Format Identification	7500
BIN	Binary Data Segment	7600
LE	Loop Trailer	7700
SE	Transaction Set Trailer	7800

COMMENTS

Notes
1/0300	The CUR segment is used to designate the currency type used in monetary amounts in the transaction set.
1/0400	The LTR segment allows for transmitting expected ranges for all occurrences of a test in the transaction set.
1/0500	The 1000 loop allows for identifying the sender and the receiver of the message and their respective account numbers.
1/0800	The REF segment is used to convey regulatory licensing identification.
2/0100	The 2000 loop occurs for each insurance company account, division, etc.
2/0200	The 2050 loop contains information about the proposed insured.
2/0300	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.
2/0400	The REF segment includes the insurance company's identification (application number, policy number, etc.).
2/0500	The N3 segment applies to the individual applicant identified in the NM1 segment at 2/0300.
2/0600	The N4 segment applies to the individual applicant identified in the NM1 segment at 2/0300.
2/0700	The DMG segment applies to the individual applicant identified in the NM1 segment at 2/0300.
2/0900	The AM1 segment is used to describe the insurance coverage being requested. The AM1 segment is also used to advise report costs.
2/1000	The PWK segment is used to indicate that additional paper reports have been sent.
2/1200	The DMA segment applies to the individual applicant identified in the NM1 segment at 2/0300.
2/1300	The QTY segment applies to the individual applicant identified in the NM1 segment at 2/0300.
2/1400	The 2100 loop repeats for each individual report. The BOR segment includes the type of report and laboratory/information provider report number.
2/1600	The MSG segment sends the narrative version of the individual report as required by the Fair Credit Reporting Act.
2/1700	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.
2/1800	The REF segment is repeated to capture multiple identification numbers for the entity identified in the NM1 at 2/1700.
2/2200	The DMA segment identifies the language spoken by the proposed insured.
2/2300	The REL segment identifies the relationship between the proposed insured and interpreter.
2/2400	The 2200 loop is used to describe the specimen received by the laboratory.
2/2900	The 2250 loop is used to identify the firm which collected and forwarded the specimen and the paramedic who collected the specimen.
2/3100	The 2300 loop repeats for each individual test being reported and provides the results for each test.
2/3400	The NM1 segment identifies the individuals or laboratory locations responsible for an individual test.
2/3600	The 2350 loop categorizes the information being reported in this and subordinate loops.
2/3700	The 2400 loop allows relationships among hierarchically-related groups of information about the insurance applicant.
2/3800	The UQS segment allows information providers to send unique questions.
2/6700	The 2450 loop contains binary data of medical images such as heart chart, ECG, etc.
2/7000	The bounded 2500 loop allows the signature(s) and identifying information for multiple people.
2/7000	The UD segment identifies the status of the signature if not included in this transaction.
2/7300	The REL segment identifies the relationship between the signee and the proposed insured.
2/7400	The DTP segment indicates the date the signature was signed.
2/7500	The 2550 loop contains binary data representing a signature and identifying information.

rev 26/11/2024