EDI 111 Individual Insurance Policy And Client Information

This X12 Transaction Set contains the format and establishes the data contents of the Abandoned Property Filings Transaction Set 111 for use within the context of an Electronic Data Interchange (EDI) environment. This transaction set is used to report abandoned property filings information, such as uncashed checks or abandoned bank account balances, to government agencies and may be used by the government agencies to distribute information on abandoned property for publication to the general public. It may also be used to initiate an Electronic Funds Transfer (EFT) payment to transfer the value of the abandoned property to the government agencies.

Segments

Position

Segment

Name

Max use

100

Transaction Set Header

Mandatory

AtMax 1

To indicate the start of a transaction set and to assign a control number

200

BHT

Beginning of Hierarchical Transaction

Mandatory

AtMax 1

To define the business hierarchical structure of the transaction set and identify the business application purpose and reference data, i.e., number, date, and time

1000

LOOP

Mandatory

GT 1

300

NM1

Individual or Organizational Name

Mandatory

AtMax 1

To supply the full name of an individual or organizational entity

400

Address Information

Opt

AtMax 3

To specify the location of the named party

500

Geographic Location

Opt

AtMax 1

To specify the geographic place of the named party

600

REF

Reference Identification

Opt

AtMax 9

To specify identifying information

700

PER

Administrative Communications Contact

Opt

AtMax 3

To identify a person or office to whom administrative communications should be directed

2000

LOOP

Mandatory

GT 1

100

Hierarchical Level

Mandatory

AtMax 1

To identify dependencies among and the content of hierarchically related groups of data segments

200

REF

Reference Identification

Opt

GT 1

To specify identifying information

300

ASI

Action or Status Indicator

Opt

GT 1

To indicate the action to be taken with the information provided or the status of the entity described

400

Industry Code

Opt

GT 1

Code to transmit standard industry codes

500

Currency

Opt

AtMax 1

To specify the currency being used in the transaction set

600

DMG

Demographic Information

Opt

AtMax 1

To supply demographic information

700

LUI

Language Use

Opt

AtMax 1

To specify language, type of usage, and proficiency or fluency

800

Geographic Location

Opt

GT 1

To specify the geographic place of the named party

900

BLI

Baseline Item Data

Opt

AtMax 1

To specify basic item data: item identification, quantity, and price

1000

LIN

Item Identification

Opt

GT 1

To specify basic item identification data

1100

UDA

Underwriting Condition

Opt

GT 1

To specify the condition under which insurance coverage is offered

1200

SPA

Status of Product or Activity

Opt

GT 1

To indicate the details and status of a product or product activity

1300

DTP

Date or Time or Period

Opt

GT 1

To specify any or all of a date, a time, or a time period

1400

BLN

Balance Information

Opt

GT 1

To provide specific balance information for financial account reporting

1500

QTY

Quantity

Opt

GT 1

To specify quantity information

1600

AMT

Monetary Amount

Opt

GT 1

To indicate the total monetary amount

1700

RPA

Rate Amounts or Percents

Opt

GT 1

To identify rate amounts or percents for a specific cost or other line item

2100

LOOP

Mandatory

GT 1

1800

PDL

Payment Details

Opt

AtMax 1

To transmit information required to establish payment or remittance activity

1900

REF

Reference Identification

Opt

GT 1

To specify identifying information

2200

LOOP

Mandatory

GT 1

2000

III

Information

Opt

AtMax 1

To report information

2100

DTP

Date or Time or Period

Opt

GT 1

To specify any or all of a date, a time, or a time period

2300

LOOP

Mandatory

GT 1

2200

AM1

Informational Values

Opt

AtMax 1

To specify a code and the amount or quantity or percentage associated with it

2300

III

Information

Opt

GT 1

To report information

2350

SPA

Status of Product or Activity

Opt

GT 1

To indicate the details and status of a product or product activity

2400

DTP

Date or Time or Period

Opt

GT 1

To specify any or all of a date, a time, or a time period

2500

AMT

Monetary Amount

Opt

GT 1

To indicate the total monetary amount

2600

QTY

Quantity

Opt

GT 1

To specify quantity information

2700

RPA

Rate Amounts or Percents

Opt

GT 1

To identify rate amounts or percents for a specific cost or other line item

2800

BLN

Balance Information

Opt

GT 1

To provide specific balance information for financial account reporting

2900

REF

Reference Identification

Opt

GT 1

To specify identifying information

2400

LOOP

Mandatory

GT 1

3000

NM1

Individual or Organizational Name

Opt

AtMax 1

To supply the full name of an individual or organizational entity

3100

Additional Name Information

Opt

AtMax 3

To specify additional names

3200

COM

Communication Contact Information

Opt

GT 1

To specify a communication contact number

2450

LOOP

Mandatory

GT 1

3300

Address Information

Opt

AtMax 1

To specify the location of the named party

3400

Geographic Location

Opt

AtMax 1

To specify the geographic place of the named party

3500

DTP

Date or Time or Period

Opt

GT 1

To specify any or all of a date, a time, or a time period

2500

LOOP

Mandatory

GT 1

3600

NX1

Property or Entity Identification

Opt

AtMax 1

To define the attributes of a property or an entity

3700

REF

Reference Identification

Opt

GT 1

To specify identifying information

3800

BEN

Beneficiary or Owner Information

Opt

AtMax 1

To supply beneficiary, co-participant, and owner information

3900

III

Information

Opt

GT 1

To report information

4000

AM1

Informational Values

Opt

GT 1

To specify a code and the amount or quantity or percentage associated with it

4100

IN1

Individual Identification

Opt

GT 1

To provide identification of an individual or entity

4200

Transaction Set Trailer

Mandatory

AtMax 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)

Elements

Position	Element	Name	Requirement	Type	Min/Max	Repeat

1	143	Transaction Set Identifier Code	Mandatory	ID	3/3	1

2	329	Transaction Set Control Number	Mandatory	Alphanumeric	4/9	1

3	1705	Implementation Convention Reference	Opt	Alphanumeric	1/35	1

EDI Dictionary

EDI 111 Individual Insurance Policy And Client Information

Segments

Elements