C.M.R. 90, 351, ch. 3, app VIII
Section 6 I AIABC Proof of Coverage Release 2.1
Standards:
Data Dictionary INTRODUCTION
This section contains the Proof of Coverage Data Dictionary. Included are data element definitions, links, and code lists necessary to successfully implement the IAIABC EDI Proof of Coverage system in your organization.
There are two data elements that are not available for use in Release 1.0. They are:
*Employee Leasing Policy Identification - DN0333
*Minimum Premium Indicator - DN0332
Use of the following triplicate code is not available for use in Release 1.0 or Release 2.0. This triplicate code is the combination of
*00 (Transaction Set Purpose Code - DN0300)
*60 (Transaction Set Type Code - DN0334)
*59 (Transaction Reason Code - DN0303)
This dictionary contains some or all of the following information for every Proof of Coverage business and technical data element to be used in Release 1.0, 2.0 and 2.1.
Definition: The meaning or purpose of the data element
Business Need:Includes a description of how the information reported in the data element is used for Proof of Coverage reporting, tracking and/or processing.
Orig/Rev.: The date that the data element was originally created followed by any revision dates, if applicable.
Source: Indicates the entity that originated and/or maintains code value structures and population rules for the data element to encourage standard usage.
Format: The field length and type of the data element
Values:When applicable, a list of valid codes and their meaning.
Record: An indication of which flat file the data element resides:
PC1 = Insured Record
PC2 = Employer Record
AK1= Proof of Coverage Acknowledgment Detail Record (R1.0, 2.0)
AKP = Proof of Coverage Acknowledgment Detail Record (R2.1 only)
ARP = Proof of Coverage Re-Acknowledgment Detail Record (R2.1 only)
HD1 = Transmission Header Record
TR1 = Transmission Trailer Record
WCP=WCPOLS Transaction
DP Rule:The data population (DP) rule(s) for the data element. Includes Implementation
notes and other process rules for the data element. Code List Disclaimer: Unused data element code values for any IAIABC standards product (Claims, Proof of Coverage, or Medical) are reserved for future IAIABC use and may not be assigned and used for any proprietary purpose. Proposals to add new codes should be submitted through the IRR process.
Acknowledgment Transaction Set ID - DN0110
Definition: The transaction set identifier that identifies the transaction being
acknowledged.
Business Need: One of the codes needed to uniquely identify the transaction being acknowledged.
Orig/Rev.:
This will be the release date
Source:
IAIABC
Format:
3 A/N
Values: POC - Proof of Coverage (See DP Rule)
PC1 - Insured Record Transaction (See DP Rule)
PC2 - Employer Record Transaction (See DP Rule)
WCP - WCPOLS Transaction
Record: AK1, AKP or ARP (Acknowledgment Record)
DP Rule:POC acknowledges at the record level (PC1 and PC2). The same Data Element is being used for this purpose as well as at the transaction level for other IAIABC products.
POC, PC1, PC2, and WCP are all valid values for Releases 1.0 and 2.0.
POC is no longer a valid value for Release 2.1.
Definition:A code used to identify the accepted / rejected status of the transaction being
Application Acknowledgment Code - DN0111 acknowledged.
Business Need: To identify to the originator whether a detail transaction was accepted or rejected by the jurisdiction, and if the jurisdiction encountered critical and/or non-critical errors in the contents of the transaction.
Orig/Rev.: 11/01/01
Source: IAIABC
Format: 2 A/N
Values: HD = Transmission Rejected
TA = Transaction Accepted by Jurisdiction
TE = Transaction Accepted with Errors by Jurisdiction
TR = Transaction Rejected by Jurisdiction
TW = Transaction Rejected by EDI Service Provider: Insufficient data to map WCPOLS to IAIABC POC file.
TN = Transaction Rejected by EDI Service Provider: Fails Jurisdiction Mandatory Requirements. AK1, AKP or
Record: ARP (Acknowledgment Record)
Definition: Date of notice to carrier/insurer of involuntary market coverage assignment.
Assign Business Need: 325 Alternative date which may be needed to determine compliance within the
involuntary market when the policy effective date is different from the date
the contract is assigned to the carrier/insurer.
Orig/Rev.: 05/03/95
Source: IAIABC
Format: 8 DATE
Record: PC1 (Insured Record)
Business Market - DN0321
Definition:A code which determines the market in which the policy/contract is written.
Business Need: Identifies the carrier/insurer relationship to the policy being written.
Orig/Rev.:05/03/95
Source:WCPOLS
Format:1A/N
Values:
Record:
1 Voluntary
2 I
n
o
v
Date Processed - DN0108
Definition: l
untary PC1 (Insured Record)
The date that the receiver processed the detail transaction. Together with time processed and a record sequence number it will uniquely identify a specific acknowledgment detail record.
Business Need: Needed for reconciliation.
Orig/Rev.: 08/09/95
Source: IAIABC
Format: 8 DATE
Record: AK1 or AKP (Acknowledgment Record)
Date Transmission Sent - DN0100
Definition: Actual date transmission of data sent.
Business Need: To identify when the transmission was sent.
Orig/Rev.: 06/07/95
Source: IAIABC
Format: 8 DATE
Record: HD1 (Header Record)
Detail Record Count - DN0106
Definition: The total number of detail records sent as part of this transmission.
Transmission header and trailer records are not included in this count.
Business Need: To indicate the number of detail records included in a transmission for verification purposes.
Orig/Rev.:
08/18/94
Source:
IAIABC
Format:
9N
Record:
TR1 (Trailer Record)
Element Error Number - DN0116
Definition: A number to uniquely identify the edit performed on an element and is part of
the error code. Business Need: Identifies the error detected.
Orig/Rev.: 07/21/93
Source: IAIABC
Format: 3 A/N
Record: AK1, AKP or ARP (Acknowledgment Record)
Element Number - DN0115
Definition: A unique number assigned to each data element and is part of the error
code. Business Need: Identifies the element for which an error was detected.
Orig/Rev.:08/18/94
Source:IAIABC
Format:4 A/N
Record:AK1, AKP or ARP (Acknowledgment Record)
Employee Leasing Policy Identification - DN0333
Definition:Code which identifies a policy written as an Employee Leasing policy, and
the type of leasing operation.
Business Need: Used by jurisdictions to identify Employee Leasing policies.
Orig/Rev.: 11/01/01
Source: WCPOLS
Format: 1 A/N
Element Number - DN0115
Definition: A unique number assigned to each data element and is part of the error code.
Business Need: Identifies the element for which an error was detected.
Orig/Rev.:08/18/94
Source:IAIABC
Format:4 A/N
Record:AK1, AKP or ARP (Acknowledgment Record)
Employee Leasing Policy Identification - DN0333
Definition:Code which identifies a policy written as an Employee Leasing policy, and the type of leasing operation.
Business Need: Used by jurisdictions to identify Employee Leasing policies.
Orig/Rev.: 11/01/01
Source: WCPOLS
Format: 1 A/N
Values: http://www.iaiabc.org/EDI/implementation.asp [File Link Not Available]
| 1 | Non-Employee Leasing Policy | Employers covered under this policy are not part of an Employee Leasing arrangement. |
| 2 | PEO Policy For Leased Workers of Multiple Client Companies | The Professional Employer Organization (PEO) is the named insured and coverage is extended to the leased workers of multiple Client Companies. The non-leased workers of the PEO may also be covered under this policy. |
| 3 | PEO Policy For Non-Leased Workers of PEO | The Professional Employer Organization (PEO) is the named insured and coverage is extended to their non-leased workers only. The leased workers of the PEO are not covered under this policy. |
| 4 | Client Company Policy For Leased Workers of Client Company | The Client Company is the named insured and the coverage is extended to the leased workers of the Client Company. The non-leased workers of the Client Company are not covered under this policy. |
| 5 | PEO Policy For Leased Workers of a Single Client Company | The Professional Employer Organization (PEO) is the named insured and coverage is extended to the leased workers of a single Client Company only. |
| 6 | Client Company Policy For Non-Leased Workers of Client Company | The Client Company is the named insured and coverage is extended to the non-leased workers of the Client Company. The Client Company is in an Employee Leasing arrangement but the leased workers are not covered under this policy. |
| 7 | Client Company Policy For Leased And Non-Leased Workers of Client Company | The Client Company is the named insured and coverage is extended to their leased and non-leased workers . |
Record: PC1 (Insured Record)
DP Rule:This element is not available for Release 1.0.
Employer Address Line 1 - DN0019
Definition: The address of the employer's facility.
Business Need: To identify the address of the employer's facility.
Orig/Rev.: 06/07/95
Source: IAIABC
Format: 30 A/N
Record: PC2 (Employer Record)
Employer Address Line 2 - DN0020
Definition: The address of the employer's facility.
Business Need:To identify the address of the employer's facility.
Orig/Rev.: 06/07/95
Source: IAIABC
Format: 30 A/N
Record: PC2 (Employer Record)
Employer City - DN0021
Definition: The city of the employer's facility.
Business Need:To identify the address of the employer's facility.
Orig/Rev.: 06/07/95
Source: IAIABC
Format: 15 A/N
Record: PC2 (Employer Record)
Employer FEIN - DN0016
Definition: The FEIN of the employer.
Business Need:To identify the employer, minimize record data, and reference employer profile data.
Orig/Rev.: 09/30/95
Source: IAIABC
Format: 9 A/N
Record: DPPC2 (Employer Record)
Rule:
The employer is denoted as any entity (e.g. DBA, AKA, TA, etc.) of the
insured. Multiple entities can exist for an insured.
Employer Name - DN0018
Definition:The name of the business entity of the insured.
Business Need: To identify the statutorily responsible employer.
Orig/Rev.:09/30/95
Source: IAIABC
Format:60 A/N
Record:PC2 (Employer Record)
DP Rule:The employer is denoted as any entity (e.g. DBA, AKA, TA, etc.) of the insured. Multiple entities can exist for an insured (including Legal entity names e.g. INC, LLC, LP).
Employer Notification Date - DN0331
Definition: The date the carrier/insurer mails the cancellation or non-renewal notification, as required by the jurisdiction.
Business Need: Informs jurisdictions of when carrier/insurer notifies the employer.
Orig/Rev.: 09/30/95
Source: IAIABC
Format: 8 DATE
Record: PC2 (Employer Record)
DP Rule:What constitutes notification will be determined by individual trading partner agreements.
Employer Postal Code - DN0023 The postal code of the employer's facility.
Definition:To identify the address of the employer's facility.
Business Need:
For the United States and its territories, this will be the USPS zip code.
Orig/Rev.:
Source:9 A/N
Format: PC2 (Employer Record)
Record:
The state of the employer's facility.
Employer State - DN0022
To identify the address of the employer's facility.
Definition:
Business Need:
Orig/Rev.: IAIABC
Source:http://www.iaiabc.org/EDI/implementation.asp [File Link Not Available]
Values:2 A/N
Format: PC2 (Employer Record)
Record: The unemployment insurance number assigned for each employer by the
Definition:jurisdiction.
Identifies the employer.
Employer UI Code - DN0329
Business Need: 15 A/N
Orig/Rev.:
PC2 (Employer Record).
Source:
Jurisdictions should identify their requirements for this alpha numeric
Format: identifier.
Record:
DP Rule:
- DN0000
DN0000 was created to express rejection of the entire batch or transaction and is communicated in the acknowledgment.
Entire Batch/Transaction
Definition:
Batch: A batch is a set of records containing one header record, one or more detail transactions and one trailer record. Trading partner tables (Transmission Profile, Element Requirement Table, System Rules, Edit Matrix, etc.) should be used to determine batch edit rules. Any batch edit failure will cause the entire batch to be rejected. If a batch is rejected, the individual transactions within the rejected batch are not processed. If a batch is accepted, the process continues to validate detail transactions within the batch.
Transaction: A POC transaction consists of 1 or more 'Records' to communicate a policy event. Failure of edits on the "primary" record will cause "all related" records to be rejected. DN0000 is used to express the rejection of the "related" records.
Business Need: Used to communicate an error at the batch or transaction level.
Orig/Rev.: 07/01/97; 05/07/04
Source:IAIABC
Format: A/N 4
Values:0000 = Entire Batch/Transaction
Not a DN located on a specific file layout. Used to communicate a batch or
Record: transaction error on AK1, AKP, ARP
See Acknowledgment Scenarios for batch error examples.
DP Rule:
* Failure of edits on the PC1 (primary) record will cause the PC2 (related) record(s) to be rejected. DN0000 is used to communicate the rejection of the related record.
* Failure of edits on the PC2 (related) record(s) may cause PC1 (primary) record to be rejected. DN0000 is used to communicate the rejection of the primary record.
Free Form Text - DN0113
Definition:An unstructured field used to convey jurisdiction information to the sender.
Only one free form text message can be generated per transaction.
Business Need: Allows for free form communication.
Orig/Rev.: 08/18/94
Source:IAIABC
Format: 60 A/N
Record: AK1, AKP or ARP (Acknowledgment Record)
Governing Class - DN0326
Definition:The rating classification identified in the policy/contract which contains the largest payroll per jurisdiction.
Business Need: Used to identify the primary operation of the insured within the jurisdiction.
Orig/Rev.:12/09/94
Source:WCPOLS
Format:4 A/N
Record:PC1 (Insured Record)
Industry Code - DN0025
Definition:The code representing the nature of the employer's business which is
contained in the industrial classification manual published by the Federal Office of Management and Budget.
Business Need: Statistical
Orig/Rev.: 11/01/01, 04/09/05
Source:http://www.iaiabc.org/EDI/implementation.asp [File Link Not Available]
Format: 6 A/N
Values Federal Office of Management & Budget - most recent version of NAICS codes Record: PC2 (Employer Record)
DP Rule: It is recommended that the Industry Code (NAICS) be required as an element on Proof of Coverage reporting PRIOR to being required as a mandatory data element on Claims transactions. It is advised that claim administrators receive this data element from their policy reporting areas.
Insured Address Line 1 - DN0315
Definition: The mailing address of the named insured contained on the policy/contract.
Business Need: Identifies the location of the insured.
Orig/Rev.: 04/13/94
Source: WCPOLS
Format: 30 A/N
Record: PC1 (Insured Record)
Insured Address Line 2 - DN0316
Definition:The mailing address of the named insured contained on the policy/contract.
Business Need: Identifies the location of the insured.
Orig/Rev.: 04/13/94
Source:WCPOLS
Format: 30 A/N
Record: PC1 (Insured Record)
Insured City - DN0317
Definition: The city of the mailing address of named insured contained on the policy/contract.
Business Need: Identifies the location of the insured.
Orig/Rev.: 04/13/94
Source: WCPOLS
Format: 30 A/N
Record: PC1 (Insured Record)
Insured FEIN - DN0314
Definition:The FEIN of the insured.
Business Need: Identifies the insured.
Orig/Rev.: 06/07/95 IAIABC
Source: 9
Format:
Record: A/N
PC1 (Insured Record)
Insured Legal Status -
Definition:
DN0323
Business Need:
Code which identifies the business ownership / management.
Orig/Rev.:
Identifies the type of business being insured.
Source:
07/01/04
Format:
WCPOLS
Values:
2 A/N
1 Individual
2 Partnership
3 Corporation
4 Association, Labor Union, Religious Organization
5 Limited Partner
6 Joint Venture
10 Limited Liability Company (LLC)
11 Trust or Estate
12 Executor or Trustee
13 Limited Liability Partnership (LLP)
14 Governmental Entity (See DP Rule) 99 Other
Record: PC1 (Insured Record) This value is not available for
DP Rule: Release 1.0.
Insured Name - DN0017
Definition: The named insured of the policy, or the financially responsible self insured approved by the jurisdiction.
Business Need: To identify the insured in a hierarchically structured organization when the employer is not the parent organization.
Orig/Rev.:
08/09/95
Source:
IAIABC
Format:
90 A/N
Record: DP PC1 (Insured Record)
Rule: The Insured Name is the primary named insured on the policy.
Insured Postal Code - DN0319
Definition:The postal code (ZIP) relating to the mailing address of named insured contained on the policy/contract.
Business Need: Identifies the location of the insured.
Orig/Rev.: 04/13/94
Source:For the United States and its territories, this will be the USPS zip code.
Format:9 A/N
Record:PC1 (Insured Record)
Insured State - DN0318
Definition: The state of the mailing address of named insured contained on the policy/contract.
Business Need: Identifies the location of the insured.
Orig/Rev.:
04/13/94
Source:
IAIABC
Values:
http://www.iaiabc.org/EDI/implementation.asp [File Link Not Available]
Format:
2 A/N
Record:
PC1 (Insured Record)
Insured Telephone Number - DN0320
Definition: The primary telephone number of the named insured contained on the policy/contract. Business Need: Provides phone number to jurisdictions for the insured.
Orig/Rev.: 09/30/94
Source: IAIABC
Format: 10 A/N
Record: PC1 (Insured Record)
Insurer FEIN - DN0006
Definition:The FEIN of the carrier or self insured assuming the employer's financial responsibility for Workers' Compensation Claim(s).
Business Need:
To identify financial responsibility and to reference claims payer data.
Orig/Rev.:
08/09/95
Source:
IAIABC
Format:
9 A/N
Record:
PC1 (Insured Record), AK1 or AKP (Acknowledgment Record)
Insurer Name - DN0007
Definition: The name of the carrier or self insured assuming the employer's financial
responsibility for Workers' Compensation Claim(s).
Business Need: To identify financial responsibility and to reference claims payer data.
Orig/Rev.:06/07/95
Source:WCPOLS
Format:30 A/N
Record:PC1 (Insured Record)
Interchange Version ID DN0105
Definition: A composite field comprised of a batch type (positions 1-3), release number (position 4) and version number (position 5). Interchange Version ID is a data element located in the Header Record. It is used to identify the batch type, release and version of the transactions contained within the batch following the Header Record through the Trailer Record. Batch type designates the type of transactions within a batch. Release number identifies the release level of the data of the record layout contained in the detail record that follow. Version number identifies the version level of the release.
Business Need:To identify the type and release level of the detail records contained within the batch transmission and to uniquely identify the version number to anticipate the format of the detail records that are to follow.
Orig/Rev.: 07/01/97, 12/31/02, 05/27/03, 1/25/06
Source: IAIABC
Format: Batch Type 3 A/N
Release Number 1 A/N Version Number 1 A/N
Values: POC01 - Proof of Coverage; Release 1, Version 0
POC02 - Proof of Coverage; Release 2, Version 0 POC21 - Proof of Coverage; Release 2, Version 1 AK101 - Acknowledgment for Proof of Coverage: Release 1, Version 0 AK101 - Acknowledgment for Proof of Coverage: Release 2, Version 0 AKP21 - Acknowledgment for Proof of Coverage: Release 2, Version 1 ARP21 - Re-Acknowledgment for Proof of Coverage: Release 2, Version 1
Record: HD1 (Header Record)
Issuing Agency Name - DN0311 Issuing Definition:N0312
Business Need: The city of the agency responsible for producing the business.
Orig/Rev.: Identifies the location of the agency producing the business policy.
Source:12/09/94
Format: IAIABC
Record: 30 A/N
PC1 (Insured Record)
The name of the agency that produced the business.
Provides alternate contact for verifying policy information.
12/09/94
IAIABC
30 A/N
PC1 (Insured Record)
Issuing Agency State - DN0313
Definition: The state of the agency that produced the business.
Business Need: Identifies the location of the agency that produced the business.
Orig/Rev.: 12/09/94
Source: IAIABC
Values: http://www.iaiabc.org/EDI/implementation.asp [File Link Not Available]
Format: 2 A/N
Record: PC1 (Insured Record)
Issuing Office Address Line 1 - DN0306
Definition: The address of the carrier's/insurer's location responsible for registering the Proof of Coverage notification to the jurisdiction. Business Need: Identifies the location of the issuing office. Orig/Rev.: 05/03/95
Source: IAIABC
Format: 30 A/N
Record: PC1 (Insured Record)
Issuing Office Address Line 2 - DN0307
Definition: The address of the carrier's/insurer's location responsible for registering the Proof of Coverage notification to the jurisdiction.
Business Need:
Identifies the location of the issuing office.
Orig/Rev.:
05/03/95
Source: IAIABC
Format: 30 A/N
Record: PC1 (Insured Record)
Issuing Office City - DN0308
Definition:The city of the carrier's/insurer's location responsible for registering the Proof
of Coverage notification to the jurisdiction.
Business Need: Identifies the location of the issuing office.
Orig/Rev.: 05/03/95
Source: IAIABC
Format: 30 A/N
Record: PC1 (Insured Record)
Issuing Office Name - DN0305
Definition:The carrier's/insurer's office responsible for registering the Proof of Coverage
Notification to the jurisdiction.
Business Need: Identifies the office that provides the proof of coverage to the jurisdictions.
Orig/Rev.: 05/03/95
Source: IAIABC
Format: 30 A/N
Record: PC1 (Insured Record)
DP Rule: Applicable to regional underwriting office or a third party issuing the policy.
Issuing Office Postal Code - DN0310
Definition: The postal code of the carrier's/insurer's location responsible for registering the Proof of Coverage notification to the jurisdiction.
Business Need: Identifies the location of the issuing office.
Orig/Rev.: 05/03/95
Source: For the United States and its territories, this will be the USPS zip code.
Format: 9 A/N
Record: PC1 (Insured Record)
Issuing Office State - DN0309
Definition:The state of the location responsible for registering the Proof of Coverage notification to the jurisdiction.
Business Need: Identifies the location of the issuing office.
Orig/Rev.: 07/11/94
Source: http://www.iaiabc.org/EDI/implementation.asp [File Link Not Available]
Format: 2 A/N
Record: PC1 (Insured Record)
Jurisdiction - DN0004
Definition: The governing body or territory whose statutes apply.
Business Need: Used to identify the jurisdiction whose statutes apply.
Orig/Rev.: 06/07/95
Source: See State code list at http://www.iaiabc.org/EDI/implementation.asp [File Link Not Available]
Or list of non-state jurisdictions below Values: Non-State Jurisdictions:
UL Longshore & Harbor Workers Compensation Act U1 Defense Base Act
U2 Non Appropriated Fund Instrumentalities Act U3 Outer Continental Shelf Act U4 War Hazards Compensation Act FC Federal Coal Mine Health & Safety Act FE Federal Employers Liability Act M1 Admiralty I & II
Format: 2 A/N
Record: PC1 (Insured Record)
Definition: The date the jurisdiction's designee (if any) received the data.
Jurisdic
Business Need:Received Date - DN0302 To determine compliance with Proof of Coverage
Orig/Rev.:reporting requirements.
Source: 07/14/97
Format: IAIABC
Record: 8 DATE
DP Rule: PC1 (Insured Record)
This element is never used by the insurer.
Minimum Premium Indicator - DN0332
Definition: Code that identifies a policy written as a Minimum Premium Policy.
Business Need: Used by jurisdictions to identify Minimum Premium policies.
Orig/Rev.: 11/01/01
Source: WCPOLS
Format: 1 A/N
Values: Y = Minimum Premium Policy
N = Non-Minimum Premium Policy
Record: PC1 (Insured Record)
DP Rule: This element is not available for Release 1.0.
Number of Employees - DN0330
Definition: The number of employees for each employer within the jurisdiction at the
time the policy/contract is issued.
Business Need: To be used by jurisdictions as an indicator for directing non-compliance of insurance coverage and accident prevention programs.
Orig/Rev.:
12/09/94
Source:
IAIABC
Format:
6 N
Record: DPPC2 (Employer Record)
Rule:In certain situations this number may be estimated.
Number of Employers - DN0328
Definition:
The number of employer segment occurrences.
Business Need: To provide a counter of employer records that will immediately follow the insured record.
Orig/Rev.:
12/09/94; 06/01/07
Source:
IAIABC
Format:
4 N
Record: DP
PC1 (Insured Record)
Rule:
If the number of employer records is less than or equal to (<=) 9999 report the total number of employer records in this field.
If the number of employer records is greater than (>) 9999, report blank in this field and report the number of employer records in positions 545 - 550
DN0336 Number of Employers Expanded.
Definition:The number of employer segment occurrences when there are more than
NumberExpanded - DN0336 9999 employer records.
Business Need: To provide a counter of employer records that will
immediately follow the
Orig/Rev.:
insured record.
Source:
06/01/07
Format:
IAIABC
Record: 6 N
DP Rule: PC1 (Insured Record)
If the number of employer records is greater than (>) 9999 report the total number of employer records in this field.
If the total number of employer locations is less than or equal to < 9999 report the total number of employer records in positions (582 - 585) DN0328 Number of Employers.
Number of Errors - DN0114
Definition: The number of error code segment occurrences.
Business Need: A technical processing requirement that specifies the number of variable segments that follow.
Orig/Rev.: 08/18/94
Source: IAIABC
Format: 2 N
Record:
AK1, AKP or ARP (Acknowledgment Record)
Original Transmission Date - DN0102
Definition:
The value obtained from the Date Transmission Sent field of the Header Record of the originating transmission.
Business Need: This field should only be populated on the acknowledgment (AK1, AKP or
ARP) batch header to allow the receiving party the ability to match back to the original batch file for reconciliation purposes. It is used in conjunction with the Original Transmission Time field in the acknowledgment process.
Orig/Rev.: 08/19/94; 10/01/06
Source: IAIABC
Format: 8 DATE
Record:HD1 (Header Record of AK1, AKP or ARP only)
Original Transmission Time - DN0103
Definition:
The value obtained from the Time Transmission Sent field of the Transmission Header Record of the originating transmission.
Business Need: This field should only be populated on the acknowledgment (AK1, AKP or
ARP) batch header to allow the receiving party the ability to match back to the original batch file for reconciliation purposes. It is used in conjunction with the Original Transmission Date field in the acknowledgment process.
Orig/Rev.: 08/19/94; 10/01/06
Source: IAIABC
Format: 6 TIME
Record:HD1 (Header Record of AK1, AKP or ARP only)
Policy Effective Date - DN0029
Definition:
The date that the contract/policy became effective.
Business Need:
To validate coverage compliance and define the begin date policy term
represented in the transaction.
Orig/Rev.:
06/07/95
Source:
IAIABC
Format:
8 DATE
Record:
PC1 (Insured Record)
Policy Expiration Date - DN0030
Definition: The date that the contract/policy expired.
Business Need:To validate coverage compliance and define the policy end date for the policy term represented in the transaction.
Orig/Rev.: 06/07/95
Source: IAIABC
Format: 8 DATE
Record: PC1 (Insured Record)
DP Rule:Notification of end date of policy term may not satisfy continuous coverage jurisdictions and their cancellation requirements.
Policy Number - DN0028
Definition: The number assigned to the policy/contract for that employer or association group.
Business Need: Identify contract.
Orig/Rev.:11/01/01
Source:WCPOLS
Format:18 A/N
Record:PC1 (Insured Record), AKP (Acknowledgment Record)
DP Rule:The policy number is reported at the insured level, which is inclusive of the employers/entities submitted on this record. Report the alphanumeric characters used for uniquely identifying the policy. Do NOT report any leading or embedded blanks, marks of punctuation, or special characters.
Prior Policy Number - DN0324
Definition:The number assigned to the prior policy/contract for that employer or
association group.
Business Need: Identify prior policy/contract number for renewals, rewrites, and binders if applicable.
Orig/Rev.:
11/01/01
Source:
WCPOLS
Format: 18 A/N
Record:
PC1 (Insured Record)
DP Rule:
The policy number is reported at the insured level, which is inclusive of the employers/entities submitted on this record. This element is only applicable in the event that the current carrier/insurer was also responsible for the previous policy. Report the alphanumeric characters used for uniquely identifying the policy. Do NOT report any embedded blanks, marks of punctuation, or special characters.
Receiver ID - DN0099
Definition:Composite or group level code made up of the Receiver FEIN (the FEIN of the receiving party), a filler, and the Receiver Postal Code (postal code of the
receiving party).
Business Need: To identify the receiving party.
Orig/Rev.: 08/18/94
Source: IAIABC
Format: 25 A/N (Receiver FEIN 9 A/N, Filler 7 spaces, Receiver Postal Code 9 A/N)
Record: HD1 (Header Record)
DP Rule:Filler is reserved for possible future use in the event FEIN is not sufficient to uniquely identify the receiving party.
Record Sequence Number - DN0107
Definition: Identifying control number that must be unique within a transmission. The number is assigned by the originator of a transaction.
Business Need: To uniquely identify a transaction in the event trading partners need to reconcile transactions.
Orig/Rev.:
12/09/94
Source:
IAIABC
Format:
9 N
Values:0= Header or batch structure Error
1thru 999999998 =
Detail Record Identifier 999999999 =
Record: Trailer Error
PC1 (Insured Record), PC2 (Employer Record), AK1, AKP or ARP
(Acknowledgment Record)
DP Rule:The Record Sequence Number returned in the acknowledgement
corresponds to the Record Sequence Number of the record of the transaction unless it is a Header, Batch Structure or Trailer Record error.
Request Code - DN0112
Definition:A code used to convey additional information such as the need to follow up or respond manually to a transaction.
Business Need: To have the ability to communicate the need for additional information associated with a transaction electronically.
Orig/Rev.:
08/18/94
Source:
IAIABC
Format:
3 A/N
Values:
0- None
1- Contact Sender
Record:
AK1, AKP or ARP
(Acknowledgment
Sender ID- DN0098
Record) Definition:
Composite or group level code made up of the Sender FEIN (the FEIN of the sending party), a filler, and the Sender Postal Code (postal code of the sending party).
Business Need: To identify the sending party.
Orig/Rev.: 08/18/94
Source: IAIABC
Format: 25 A/N (Sender FEIN 9 A/N, Filler 7 spaces, Sender Postal Code 9 A/N)
Record: HD1 (Header Record)
DP Rule:Filler is reserved for possible future use in the event FEIN is not sufficient to uniquely identify the sending party.
Test/Production Code - DN0104
Definition: The trading partner's EDI participation status for a specific transaction.
Business Need:To communicate whether the batch transmitted is in a test or production status.
Orig/Rev.:
08/18/94
Source:
IAIABC
Format: 1 A/N
Values: T = Test (pilot/parallel or test)
P = Production Record:
HD1 (Header Record)
Time Processed - DN0109
Definition:
The time that the receiver processed the detail transaction. Together with date processed and a record sequence number it will uniquely identify a specific acknowledgment detail record.
Business Need: Needed for reconciliation.
Orig/Rev.: 08/09/95
Source: IAIABC
Format: 6 TIME
Record: AK1, AKP or ARP (Acknowledgment Record)
Time Transmission Sent - DN0101
Definition:
The time the sender prepared the batch file for transmission. Together with the Date Transmission Sent will uniquely identify a specific transmission batch.
Business Need: Needed for reconciliation. Orig/Rev.:08/09/95
Source:IAIABC
Format:6 TIME
Record:HD1 (Header Record)
Total Payroll - DN0327
Definition:The sum of the payroll amounts in whole dollars for the rating classification identified in the policy/contract term per jurisdiction.
Business Need:
Could be used to estimate the size of the employer.
Orig/Rev.:09/30/95
Source:WCPOLS
Format:11 N
Record:PC1 (Insured Record)
Transaction Issue Date DN0335
Definition:The issue date of the Transaction Set Type code DN0334 being submitted.
This date is the accounting date on which the data represented by this transaction code was processed by the insurer's policy issuance system.
Business Need:To indicate the date a transaction, e.g. Binder, New Policy, Renewal Policy,
Endorsement, Cancellation, Rewrite/Reissue, Non-renewal or Reinstatement was issued by the carrier's policy issuance system
Orig/Rev.: 05/06/05
Source: WCPOLS
Format: 8 DATE
Record: PC1 (Insured Record)
Transaction Reason Code
- DN0303
Definition:
Code which further identifies the type of transaction being submitted.
Business Need:
Identifies for the jurisdiction why the transaction was sent.
Orig/Rev.:
07/01/04
Source:
ANSI 1203
Format:
2 A/N
Values:
01 No Specific Transaction Reason Code Utilized
45 Out of Business/Retired from Business
54 Adding an Employer Location
56 Deleting an Employer Location
59 Non Payment *
60 Coverage Placed Elsewhere
61 Duplicate Coverage
62 Change in Ownership
63 Business Sold
64 Underwriting Reason
65 No Employees/No Exposure/No Operations/Completed Operations
66 Revocation of Voluntary Market Acceptance
67 Include Corporate Officer/Partner/Sole Proprietor
68 Exclude Corporate Officer/Partner/Sole Proprietor
69 Failure to Pay Deductible
70 Misrepresentation of Information on Application
71 Rewritten/Reissue
72 Adding a Jurisdiction
73 Deleting a Jurisdiction
76 Insured FEIN
77 Employer FEIN
78 Employer UI Number
79 Policy Number
80 No Specific Location in Jurisdiction
81 Policy Effective Date
82 Policy Expiration Date
83 Carrier/Insurer FEIN
84 Insured Record Information Not Otherwise Classified
85 Employer Record Information Not Otherwise Classified
86 Named Employer(s) With No Jurisdiction Address
87 Employer(s) With No Jurisdiction Address
94 Employer Name - Employer With No Jurisdiction Address
95 Employer UI Number - Employer With No Jurisdiction Address
96 Employer FEIN - Employer With No Jurisdiction Address Record:
PC1 (Insured Record), AKP or ARP (Acknowledgment Record) DP Rule: The following triplicate code combination is not available in Release 1.0 or 2.0:
* 00 (Transaction Set Purpose Code - DN0300)
* 60 (Transaction Set Type Code - DN0334)
* 59 (Transaction Reason Code - DN0303)
Transaction Set ID - DN0001
Definition:A code that identifies the transaction being sent/received.
Business Need:Data processing.
Orig/Rev.:07/01/04, 01/25/06
Source:IAIABC
Format: 3 A/N
Values:HD1 Header Record
PC1 POC Insured Record
PC2 POC Employer Record
TR1 Trailer Record
AK1 Acknowledgment Detail Record
AKP Acknowledgment Detail Record (See DP Rule)
ARP Re-Acknowledgment Detail Record (See DP Rule)
Record:HD1 (Header Record), PC1 (Insured Record), PC2 (Employer Record), TR1 (Trailer Record), AK1, AKP or ARP (Acknowledgment Record)
DP Rule:This value is not available for use in Release 1.0 or 2.0.
Transaction Set Purpose Code - DN0300
Definition:Code identifying purpose of transaction set.
Business Need:Identify whether the transaction set is an original or follow-up transmission of data.
Orig/Rev.:11/01/01
Source:ANSI 353
Format: 2 A/N
Values:00 Original
4Change
5Replace
Record:PC1 (Insured Record), AKP or ARP (Acknowledgment Record)
DP Rule:Transaction Set Purpose Codes 04 and 05 are only used in paired transactions. For proper usage of paired transactions please refer to the scenario documentation.
The following triplicate code combination is not available in Release 1.0 or 2.0:
* 00 (Transaction Set Purpose Code - DN0300)
* 60 (Transaction Set Type Code - DN0334)
* 59 (Transaction Reason Code - DN0303)
Transaction Set Type Code - DN0334
Definition:Defines the specific purpose of individual records within the transaction being transmitted.
Business Need: Identifies the purpose of the transaction.
Orig/Rev.: 07/01/04
Source: IAIABC
Format: POC
2 A/N
Values:
05 Binder
A temporary agreement which legally provides insurance protection until the issuance of a formal contract.
10 New Policy
The initial issuance of a policy/contract.
20 Renewal Policy
Continuation of an insurance policy/contract.
31 - 33 Endorsement
Modification to a contract after initial notification of coverage to the jurisdiction.
31 Add
32 Change
33 Delete 41 - 42 Cancellation
Discontinuation of a contract other than at expiration date.
41 Canceled by Carrier/Insurer
42 Canceled by Insured 50Rewrite/Reissue
The issuance of a policy for a given insured after a previously issued policy, covering the same term for that insured, has been canceled flat. 60Non Renewal
A cancellation at policy expiration date. 70Reinstatement
A notice to the insured that restores a policy that had been previously canceled. PC1 (Insured Record), AKP or ARP (Acknowledgment Record: Record) The following triplicate code combination is not available in Release 1.0 or 2.0: DP Rule: * 00 (Transaction Set Purpose Code - DN0300)
* 60 (Transaction Set Type Code - DN0334)
* 59 (Transaction Reason Code - DN0303)
Transaction Set Type Effective Date - DN0304
Definition:The date that the transaction reflecting the Transaction Set Type Code is effective.
Business Need:Used by jurisdictions to determine when the action denoted by the transaction will actually be effective.
Orig/Rev.: 06/07/95
Source:WCPOLS
Format: 8 DATE
Record:PC1 (Insured Record)
Wrap-up Indicator - DN0322
Definition:A code which identifies a policy written for a specific job site which will include more than one insured.
Business Need:Identifies a unique policy from the insured's primary policy.
Orig/Rev.: 12/09/94
Source:WCPOLS
Format: 1 A/N
Values:1 Wrap-up
2 No Wrap-up Record:PC1 (Insured Record)
C.M.R. 90, 351, ch. 3, app VIII