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X12 transaction guide · Healthcare and insurance

EDI 111 Individual Insurance Policy and Client Information

The X12 document used to exchange policy and client information for individual life and health insurance contracts with agents and brokers.

Sent by
Insurance company or administrator
Received by
Agents, brokers or other trading partners
Standard
ANSI ASC X12

What is an EDI 111?

The EDI 111 Individual Insurance Policy and Client Information is the ANSI X12 transaction set used to exchange policy and client information among organizations that administer individual life and health insurance contracts and their trading partners, such as agents and brokers.

Agents need to see the policies they sold: coverage, premiums, values, beneficiaries and status. Delivering policy data electronically to agency management systems lets agents service clients and spot issues such as lapsing policies without calling the insurer. Policy information is sensitive, so exchanges must follow privacy rules.

How the EDI 111 worksDiagram of the EDI 111 Individual Insurance Policy and Client Information. Insurance company or administrator sends it to agents, brokers or other trading partners. It usually starts the exchange. It is usually followed by 997. Inside the ISA, GS and ST envelopes, X12 release 008010 requires, in the heading: BHT (Beginning of Hierarchical Transaction) and the required 1000 loop with NM1 (Individual or Organizational Name) and detail: the required 2000 loop with HL (Hierarchical Level). 5 optional loops are listed by their first segment.How the EDI 111 worksIndividual Insurance Policy and Client Information: who sends it, where it fits and what the standard marksrequired1 WHERE IT FITSUSUALLY FOLLOWSStarts the exchangeEDI 111SENDERInsurance company oradministratorRECEIVERAgents, brokers orother trading partners997 or 999 acknowledgment back, if the partners agreeUSUALLY FOLLOWED BY997FunctionalAcknowledgment2 WHAT X12 RELEASE 008010 REQUIRESInterchange: sender and receiver IDsISA … IEAFunctional group, ID code IFGS … GETransaction set 111ST … SEHEADINGBHTBeginning of Hierarchical TransactionRequired loop 1000 · repeats many timesNM1Individual or Organizational NameDETAILRequired loop 2000 · repeats many timesHLHierarchical Level+ 5 optional loops, starting with:PDLIIIAM1NM1NX1Blue box: required loop. Optional loops are listed by the segment that starts them; when a loop is used, that first segment is required. Optional segmentsoutside loops are not drawn.Structure: required segments and loops in the X12 008010 listing for the 111. Your trading partner's implementation guide adds its own requirements.
How the EDI 111 worksDiagram of the EDI 111 Individual Insurance Policy and Client Information. Insurance company or administrator sends it to agents, brokers or other trading partners. It usually starts the exchange. It is usually followed by 997. Inside the ISA, GS and ST envelopes, X12 release 008010 requires, in the heading: BHT (Beginning of Hierarchical Transaction) and the required 1000 loop with NM1 (Individual or Organizational Name) and detail: the required 2000 loop with HL (Hierarchical Level). 5 optional loops are listed by their first segment.How the EDI 111 worksIndividual Insurance Policy and ClientInformation: who sends it, where it fits andwhat the standard marks required1 WHERE IT FITSUSUALLY FOLLOWSStarts the exchangeEDI 111SENDERInsurancecompany oradministratorRECEIVERAgents, brokersor other tradingpartners997 or 999 acknowledgment back, if the partnersagreeUSUALLY FOLLOWED BY997Functional Acknowledgment2 WHAT X12 RELEASE 008010 REQUIRESInterchange: sender and receiver IDs (ISA… IEA)Functional group, ID code IF (GS … GE)Transaction set 111 (ST … SE)HEADINGBHTBeginning of HierarchicalTransactionRequired loop 1000 · repeatsmany timesNM1Individual orOrganizational NameDETAILRequired loop 2000 · repeatsmany timesHLHierarchical Level+ 5 optional loops, starting with:PDLIIIAM1NM1NX1Blue box: required loop. Optional loops are listedby the segment that starts them; when a loop isused, that first segment is required. Optionalsegments outside loops are not drawn.Structure: required segments and loops in the X12008010 listing for the 111. Your trading partner'simplementation guide adds its own requirements.

How to read this diagram: the top row shows who sends the 111, to whom, and which documents usually come before and after it. The lower part shows what X12 release 008010 itself requires: the envelopes around the 111 and the segments and loops the standard marks as required, area by area. Optional loops are listed by the segment that starts them rather than drawn in full. This is the standard's minimum, not a trading partner's requirement: each partner's implementation guide usually makes some optional loops mandatory, restricts the codes and may use a different release.

Expand diagram Download SVG

When it is used

  • Updating agents' records of in-force policies
  • Sharing policy values and status changes
  • Informing agents of lapses and reinstatements

Where it fits in the document flow

This document 111 Individual Insurance Policy and Client Information
Usually followed by 997 Functional Acknowledgment

Structure

Mandatory segments in the 111 (X12 release 008010)

The segments X12 release 008010 marks as mandatory at their level, in order. Segments inside optional loops are needed only when the loop is used. This is the standard's requirement, not your trading partner's: each partner's implementation guide names the release it uses, adds the optional segments it requires and restricts the values. The requirement status comes from one published X12 reference listing and has not been checked against a second source.

  • ST
  • BHT
  • NM1
  • HL
  • PDL
  • III
  • AM1
  • N3
  • NX1
  • SE

Practical example

The 111 in practice

An insurer sends each of its agencies a weekly 111 with updates on the policies they serviced: premium changes, cash values, beneficiary changes and policies at risk of lapse. An agency's management system flags clients with lapse warnings, and the agents contact them before coverage ends.

Implementation

Implementation considerations for the 111

  • Protect client personal and health data under privacy laws.
  • Share only the policies each agent is authorized to see.
  • Keep agency records synchronized with policy changes.
  • Agree whether updates are full snapshots or changes only.

How ECOM helps

Automate the 111 with ECOM

Industry

Financial Services

Secure file transfer and B2B integration for banks and financial institutions.

Industry

Healthcare

Secure B2B integration and file transfer for providers, suppliers, distributors and healthcare partners.

Solution

B2B Integration

Connect every customer, supplier, carrier and bank across EDI, API, file and portal channels.

More general questions about EDI are answered in the EDI FAQ.

Related transactions

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