187 - Premium Audit Request and Return

FUNCTIONAL GROUP=AE

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.

SCHEMA

ST

Segment	Name	Position
ST	Transaction Set Header	0100
BGN	Beginning Segment	0200
MSG	Message Text	0300
REF	Reference Information	0400
PER	Administrative Communications Contact	0500
DTP	Date or Time or Period	0600

1000

Segment	Name	Position
N1	Party Identification	0700
N2	Additional Name Information	0800
N3	Party Location	0900
N4	Geographic Location	1000
REF	Reference Information	1100
PER	Administrative Communications Contact	1200

2000

Segment	Name	Position
HL	Hierarchical Level	0100

2100

Segment	Name	Position
LX	Transaction Set Line Number	0200
VEH	Vehicle Information	0300
VAT	Vehicle Attribute	0400
DVI	Dynamic Vehicle Information	0500
SI	Service Characteristic Identification	0600
PID	Product/Item Description	0700
MEA	Measurements	0800
REF	Reference Information	0900
AMT	Monetary Amount Information	1000
AD1	Adjustment Amount	1100
DTP	Date or Time or Period	1200
TXI	Tax Information	1300

2110

Segment	Name	Position
QTY	Quantity Information	1400
SI	Service Characteristic Identification	1500

2120

Segment	Name	Position
EFI	Electronic Format Identification	1600
BIN	Binary Data Segment	1700

2200

Segment	Name	Position
NM1	Individual or Organizational Name	1800
N2	Additional Name Information	1900
N3	Party Location	2000
N4	Geographic Location	2100
DMG	Demographic Information	2200
DMA	Additional Demographic Information	2300
MEA	Measurements	2400
NX2	Location ID Component	2500
REF	Reference Information	2600
PER	Administrative Communications Contact	2700

2300

Segment	Name	Position
III	Information	2800
SI	Service Characteristic Identification	2900
PID	Product/Item Description	3000
MEA	Measurements	3100
REF	Reference Information	3200
DTP	Date or Time or Period	3300
MSG	Message Text	3400
AMT	Monetary Amount Information	3500
AD1	Adjustment Amount	3600
CRC	Conditions Indicator	3700
PCT	Percent Amounts	3800
PDP	Property Description - Personal	3900
PDR	Property Description - Real	4000
PDS	Property Description/Legal Description	4100

2310

Segment	Name	Position
SUP	Supplementary Information	4200
MEA	Measurements	4300
REF	Reference Information	4400
DTP	Date or Time or Period	4500
AMT	Monetary Amount Information	4600
AD1	Adjustment Amount	4700

2320

Segment	Name	Position
QTY	Quantity Information	4800
SI	Service Characteristic Identification	4900

2330

Segment	Name	Position
LQ	Industry Code Identification	5000
AMT	Monetary Amount Information	5100
AD1	Adjustment Amount	5200
PCT	Percent Amounts	5300

2340

Segment	Name	Position
NM1	Individual or Organizational Name	5400
N2	Additional Name Information	5500
N3	Party Location	5600
N4	Geographic Location	5700
DMG	Demographic Information	5800
DMA	Additional Demographic Information	5900
NX2	Location ID Component	6000
REF	Reference Information	6100
PER	Administrative Communications Contact	6200

2350

Segment	Name	Position
ITA	Allowance, Charge or Service	6300
DTP	Date or Time or Period	6400
REF	Reference Information	6500
CUR	Currency	6600

TDS

Segment	Name	Position
TDS	Total Monetary Value Summary	0100

3000

Segment	Name	Position
ITA	Allowance, Charge or Service	0200
DTP	Date or Time or Period	0300
REF	Reference Information	0400
CUR	Currency	0500

3100

Segment	Name	Position
BAL	Balance Detail	0600
DTP	Date or Time or Period	0700

3200

Segment	Name	Position
N1	Party Identification	0800

3210

Segment	Name	Position
BAL	Balance Detail	0900
DTP	Date or Time or Period	1000

3220

Segment	Name	Position
ITA	Allowance, Charge or Service	1100
DTP	Date or Time or Period	1200
REF	Reference Information	1300
CUR	Currency	1400
SE	Transaction Set Trailer	1500

COMMENTS

Notes
2/0100	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
2/0100	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.
2/0100	The operating unit level is optional and if used, must immediately follow the company/corporation level.
2/0100	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.
2/0100	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.
2/0100	The support document level is optional and when used, will always immediately follow the provider of service level.
2/0200	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.
2/1800	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).
2/2800	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).
2/4200	Loop 2310 contains supporting detail by specified date for an insurance policy (HL65) or an employee (HL64).
2/4800	Loop 2320 contains quantitative detail necessary to the audit of certain types of insurance policies (HL65).
2/5000	Loop 2330 contains monetary or financial detail necessary to the audit of certain types of insurance policies (HL65).
2/5400	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).
2/6300	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).

rev 26/11/2024