148 Report of Injury, Illness or Incident
148 Report of Injury, Illness or Incident
Function Group IJ
This Draft Standard for Trial Use contains the format and establishes the data contents of the Report of Injury, Illness or Incident Transaction Set (148) for use within the context of an Electronic Data Interchange (EDI) environment. The transaction set can be used to report information pertaining to an injury, illness or incident to entities interested in the information for statistical, legal, and claims and risk management processing requirements.
Position
Segment
Name
Max Use
010
Transaction Set HeaderMandatory
Max 1
To indicate the start of a transaction set and to assign a control number
020
Beginning SegmentMandatory
Max 1
To indicate the beginning of a transaction set
022
CurrencyOptional
Max 1
To specify the currency (dollars, pounds, francs, etc.) used in a transaction
024
QuantityOptional
Max 1
To specify quantity information
NM1Loop
Optional
Repeat >1
030
Individual or Organizational NameMandatory
Max 1
To supply the full name of an individual or organizational entity
040
Additional Name InformationOptional
Max 1
To specify additional names or those longer than 35 characters in length
050
Address InformationOptional
Max 2
To specify the location of the named party
060
Geographic LocationOptional
Max 1
To specify the geographic place of the named party
070
Administrative Communications ContactOptional
Max 3
To identify a person or office to whom administrative communications should be directed
080
Account IdentificationOptional
Max 9
To specify account information
090
Date or Time or PeriodOptional
Max 9
To specify any or all of a date, a time, or a time period
100
Demographic InformationOptional
Max 1
To supply demographic information
110
Reference IdentificationOptional
Max 9
To specify identifying information
Position
Segment
Name
Max Use
HLLoop
Mandatory
Repeat 999999
010
Hierarchical LevelMandatory
Max 1
To identify dependencies among and the content of hierarchically related groups of data segments
020
Account IdentificationOptional
Max 2
To specify account information
030
Date or Time or PeriodOptional
Max >1
To specify any or all of a date, a time, or a time period
040
CurrencyOptional
Max 1
To specify the currency (dollars, pounds, francs, etc.) used in a transaction
050
Monetary AmountOptional
Max >1
To indicate the total monetary amount
060
Financial ContributionOptional
Max 2
To specify the financial contribution information
070
Reference IdentificationOptional
Max >1
To specify identifying information
080
Demographic InformationOptional
Max 1
To supply demographic information
090
QuantityOptional
Max >1
To specify quantity information
100
Claim Report InformationOptional
Max >1
To specify information about the claim being reported
110
EmploymentOptional
Max 1
To specify employment information
120
Conditions IndicatorOptional
Max >1
To supply information on conditions
125
Vehicle InformationOptional
Max >1
To provide descriptions that identify a specific vehicle
NM1Loop
Mandatory
Repeat 999
130
Individual or Organizational NameMandatory
Max 1
To supply the full name of an individual or organizational entity
140
Additional Name InformationOptional
Max 1
To specify additional names or those longer than 35 characters in length
150
Address InformationOptional
Max 2
To specify the location of the named party
160
Geographic LocationOptional
Max 1
To specify the geographic place of the named party
170
Administrative Communications ContactOptional
Max 3
To identify a person or office to whom administrative communications should be directed
172
Account IdentificationOptional
Max 9
To specify account information
174
Date or Time or PeriodOptional
Max 9
To specify any or all of a date, a time, or a time period
176
Demographic InformationOptional
Max 1
To supply demographic information
178
Reference IdentificationOptional
Max >1
To specify identifying information
ESILoop
Optional
Repeat 99
180
Employment Status InformationMandatory
Max 1
To specify status of employment
190
Date or Time or PeriodOptional
Max >1
To specify any or all of a date, a time, or a time period
200
QuantityOptional
Max >1
To specify quantity information
202
Conditions IndicatorOptional
Max 9
To supply information on conditions
AINLoop
Optional
Repeat 99
210
IncomeMandatory
Max 1
To provide type and amount of income obtained
220
CurrencyOptional
Max 1
To specify the currency (dollars, pounds, francs, etc.) used in a transaction
230
Tax InformationOptional
Max 9
To specify tax information
240
Work ScheduleOptional
Max 99
To specify an individual's work schedule
250
Date or Time or PeriodOptional
Max >1
To specify any or all of a date, a time, or a time period
260
QuantityOptional
Max 9
To specify quantity information
LNLoop
Optional
Repeat 999
270
Loan InformationMandatory
Max 1
To specify information about the loan
280
Reference IdentificationOptional
Max 2
To specify identifying information
AMTLoop
Optional
Repeat 99
290
Monetary AmountMandatory
Max 1
To indicate the total monetary amount
300
Date or Time or PeriodOptional
Max >1
To specify any or all of a date, a time, or a time period
IIILoop
Optional
Repeat >1
320
InformationMandatory
Max 1
To report information
330
Impairment DetailOptional
Max 6
To specify impairment to a body part
340
Date or Time or PeriodOptional
Max >1
To specify any or all of a date, a time, or a time period
342
Conditions IndicatorOptional
Max 9
To supply information on conditions
LMLoop
Optional
Repeat >1
345
Code Source InformationMandatory
Max 1
To transmit standard code list identification information
346
Industry CodeMandatory
Max >1
Code to transmit standard industry codes
NM1Loop
Optional
Repeat 999
350
Individual or Organizational NameMandatory
Max 1
To supply the full name of an individual or organizational entity
360
Additional Name InformationOptional
Max 1
To specify additional names or those longer than 35 characters in length
370
Address InformationOptional
Max 2
To specify the location of the named party
380
Geographic LocationOptional
Max 1
To specify the geographic place of the named party
390
Administrative Communications ContactOptional
Max 2
To identify a person or office to whom administrative communications should be directed
392
Account IdentificationOptional
Max 9
To specify account information
394
Date or Time or PeriodOptional
Max >1
To specify any or all of a date, a time, or a time period
396
Demographic InformationOptional
Max 1
To supply demographic information
398
Reference IdentificationOptional
Max >1
To specify identifying information
AD1Loop
Optional
Repeat 999
400
Adjustment AmountMandatory
Max 1
To specify the characteristics of an adjustment
410
CurrencyOptional
Max 1
To specify the currency (dollars, pounds, francs, etc.) used in a transaction
420
Date or Time or PeriodOptional
Max >1
To specify any or all of a date, a time, or a time period
430
QuantityOptional
Max >1
To specify quantity information
440
RelationshipOptional
Max 30
To specify relationship and birth order of entity
NM1Loop
Optional
Repeat 999
450
Individual or Organizational NameMandatory
Max 1
To supply the full name of an individual or organizational entity
460
Additional Name InformationOptional
Max 1
To specify additional names or those longer than 35 characters in length
470
Address InformationOptional
Max 2
To specify the location of the named party
480
Geographic LocationOptional
Max 1
To specify the geographic place of the named party
490
Administrative Communications ContactOptional
Max 2
To identify a person or office to whom administrative communications should be directed
492
Account IdentificationOptional
Max 9
To specify account information
494
Date or Time or PeriodOptional
Max 9
To specify any or all of a date, a time, or a time period
496
Demographic InformationOptional
Max 1
To supply demographic information
498
Reference IdentificationOptional
Max 9
To specify identifying information
Position
Segment
Name
Max Use
LXLoop
Optional
Repeat 1
010
Assigned NumberMandatory
Max 1
To reference a line number in a transaction set
020
QuantityOptional
Max 99
To specify quantity information
030
Transaction Set TrailerMandatory
Max 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)