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You are here: Home . wc . news . advisories . ad2002-07b-00

ADVISORY 2002-07B

SUBJECT: Electronic Submission of Proof of Coverage (Commercial Carriers)

The Texas Workers' Compensation Commission (Commission) has amended the Texas State Profile attached to Advisory 2002-07 to allow commercial insurance carriers to submit the IAIABC Proof of Coverage Binder transaction when needed to meet the proof of coverage filing timeliness requirements in Texas Labor Code 406.006 and Rule 110.1(f)(1). The carrier may submit the Binder transaction when "The Carrier/Insurer has written a temporary agreement, which legally provides coverage until the Carrier/Insurer issues a formal contract (policy)." as specified in the IAIABC EDI Implementation Guide for Proof of Coverage, Release 2, May 1, 2002 Edition. The Commission requires that a New Policy or Renewal transaction be submitted to replace the Binder transaction when the policy is issued. If a policy is not subsequently issued, the carrier must submit a policy (binder) cancellation transaction and the cancellation notice provisions of Texas Labor Code 406.008 and Rule 110.1(f)(2) and (3) and (g) apply.

Questions concerning this change in process should be directed to Robin Miksch, Chief, Records Processing, (512) 804-4372, robin.miksch@tdi.texas.gov.

Signed this 28th day of August, 2002

Richard F. Reynolds, Executive Director

Attachments: Texas State Profile

Distribution:
TWCC Staff
Carrier Representatives
Forms Notification List
Public Information List
TWCC Website


TEXAS STATE PROFILE
(August 26, 2002)

REQUIRED IAIABC TRANSACTIONS

Texas will use all IAIABC Proof of Coverage transactions as specified in the IAIABC Proof of Coverage Release 2 Implementation Guide.

EDITS BY DATA COLLECTION AGENT

All IAIABC edits will be accomplished.
All Texas mandatory fields and appropriate conditional fields must be present.
WCPOLS transactions must contain all appropriate name and address records, including Name Link Codes, to identify all entities covered by the policy.

FIELD REQUIREMENTS (R/C/O, Required/Conditional/Optional)

Header Record Layout
ELEM # LOCATION LENGTH GROUPING FIELD NAME TEXAS
DN001 1 - 3 3 Transaction Transaction Set ID R
DN098 4 - 28 25 Sender Sender ID -
9 Sender Fein R
7 Filler -
9 Sender Postal Code R
DN099 29 - 53 25 Receiver Receiver ID -
9 Receiver Fein R
7 Filler -
9 Receiver Postal Code R
DN100 54 - 61 8 Transmission Date Transmission Sent R
DN101 62 - 67 6 Time Transmission Sent R
DN102 68 - 75 8 Original Transmission Date C 1
DN103 76 - 81 6 Original Transmission Time C 1
DN104 82 - 82 1 Test/Prod Indicator R
DN105 83 - 87 5 Interchange Version ID -
3 Transmission Type Code R
2 Version Number R

Trailer Record Layout
ELEM # LOCATION LENGTH GROUPING FIELD NAME TEXAS
DN001 1 - 3 3 Transaction Transaction Set ID R
DN106 4 - 12 9 Detail Record Count R

INSURED RECORD LAYOUT
ELEM # LOCATION LENGTH GROUPING FIELD NAME TEXAS
DN001 1 - 3 3 Transaction Transaction Set ID R
DN107 4 - 12 9 Record Sequence Nbr R
DN300 13 - 14 2 Transaction Set Purpose Code R
DN302 15 - 22 8 Jurisdiction Designee Received Date R
DN002 23 - 24 2 Transaction Set Type Code R
DN303 25 - 26 2 Transaction Reason Code R
DN304 27 - 34 8 Transaction Set Type Effective Date R
DN006 35 - 43 9 Insurer Insurer Fein R
DN007 44 - 73 30 Insurer Name R
DN305 74 - 103 30 Issuing Office Name O
DN306 104 - 133 30 Issuing Office Address Line 1 O
DN307 134 - 163 30 Issuing Office Address Line 2 O
DN308 164 - 193 30 Issuing Office City O
DN309 194 - 195 2 Issuing Office State O
DN310 196 - 204 9 Issuing Office Postal Code O
DN311 205 - 234 30 Agency Issuing Agency Name O
DN312 235 - 264 30 Issuing Agency City O
DN313 265 - 266 2 Issuing Agency State O
DN314 267 - 275 9 Insured Insured Fein R
DN017 276 - 365 90 Insured Name R
DN315 366 - 395 30 Insured Address Line 1 R
DN316 396 - 425 30 Insured Address Line 2 C 2
DN317 426 - 455 30 Insured City R
DN318 456 - 457 2 Insured State R
DN319 458 - 466 9 Insured Postal Code R
DN320 467 - 476 10 Insured Telephone Number O
DN321 477 - 477 1 Business Market R
DN322 478 - 478 1 Wrap-Up Indicator R
DN323 479 - 480 2 Insured Legal Status O
DN028 481 - 498 18 Policy Policy Number R
DN333 499 - 499 1 Employee Leasing Policy Identification R
DN332 500-500 1 Minimum Premium Indicator O
501 - 510 10 Filler
DN029 511 - 518 8 Policy Effective Date R
DN030 519 - 526 8 Policy Expiration Date R
DN324 527 - 544 18 Prior Policy Number C 3
545 - 556 12 Filler
DN325 557 - 564 8 Assignment Date O
DN004 565 - 566 2 Jurisdiction Jurisdiction R
DN326 567 - 570 4 Governing Class O
DN327 571 - 581 11 Total Payroll O
DN328 582 - 585 4 Employer Cnt Number of Employers R

Employer Record Layout
ELEM # LOCATION LENGTH GROUPING FIELD NAME TEXAS
DN001 1 - 3 3 Employer Segment Transaction Set ID R
DN107 4 - 12 9 Record Sequence Nbr R
DN016 13 - 21 9 Employer Fein R
DN329 22 - 36 15 Employer UI Code O
DN018 37 - 96 60 Employer Name R
DN019 97 - 126 30 Employer Address Line 1 R
DN020 127 - 156 30 Employer Address Line 2 C 2
DN021 156 - 171 15 Employer City R
DN022 172 - 173 2 Employer State R
DN023 174 - 182 9 Employer Postal Code R
DN025 183 - 188 6 Industry Code O
DN330 189 - 194 6 Number of Employees O
DN331 195 - 202 8 Employer Notification Date C 4

POC Acknowledgment Record Layout
ELEM # LOCATION LENGTH GROUPING FIELD NAME TEXAS
DN001 1 - 3 3 Detail Acknowledgment Transaction Set ID R
DN107 4 - 12 9 Record Sequence Nbr R
DN108 13 - 20 8 Date Processed R
DN109 21 - 26 6 Time Processed R
DN006 27 - 35 9 Filler -
DN014 36 - 44 9 Filler -
DN008 45 - 53 9 Filler -
DN110 54 - 56 3 Acknowledgment Transaction Set ID R
DN111 57 - 58 2 Application Acknowledgment Code R
DN026 59 - 83 25 Filler -
DN015 84 - 108 25 Filler -
DN005 109 - 133 25 Filler -
DN002 134 - 135 2 Filler -
DN003 136 - 143 8 Filler -
DN112 144 - 146 3 Request Code (Purpose) R
DN113 147 - 206 60 Free form text -
DN114 207 - 208 2 Nbr of errors R
Variable Segment
Occurs Number of Error Times
DN115 209 - 212 4 Error Code Element Number C 5
DN116 213 - 215 3 Element Error Number C 5
DN117 216 - 217 2 Variable Segment Number C 5

C 1- Required on header record for AK1.

C 2- The Address Line 2: R when information is provided in that field by the sender.

C 3- Prior Policy Number: R only for renewal coverage. If there is no prior term (New Business policies), leave blank.

C 4- Employer Notification Date: R for all cancellations and non-renewals.

C 5- Used only when errors exist.



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