972-836-7750 Request a demo Talk to an expert
Talk to an expert Request a demo Call sales 972-836-7750

X12 transaction guide · Healthcare and insurance

EDI 255 Underwriting Information Services

The X12 document used to request underwriting services from information providers and to request or receive the status of those requests.

Sent by
Insurance company or distributor
Received by
Information provider
Standard
ANSI ASC X12

What is an EDI 255?

The EDI 255 Underwriting Information Services is the ANSI X12 transaction set that can be used to request specific services from information providers in support of underwriting. It can also be used between trading partners to request and receive the status of those requests.

Underwriting an individual policy can require several services from different providers. Ordering them electronically and tracking their status lets the insurer manage the underwriting timeline and tell the agent what is outstanding. Results come back in the 186.

How the EDI 255 worksDiagram of the EDI 255 Underwriting Information Services. Insurance company or distributor sends it to information provider. It usually follows 267. It is usually followed by 186 and 997. Inside the ISA, GS and ST envelopes, X12 release 008010 requires, in the heading: BGN (Beginning Segment) and detail: the required ACT loop with ACT (Account Identification) and the required NM1 loop with NM1 (Individual or Organizational Name) and the required LX loop with LX (Transaction Set Line Number). 3 optional loops are listed by their first segment.How the EDI 255 worksUnderwriting Information Services: who sends it, where it fits and what the standard marks required1 WHERE IT FITSUSUALLY FOLLOWS267Individual Life, Annuityand Disability ApplicationEDI 255SENDERInsurance company ordistributorRECEIVERInformation provider997 or 999 acknowledgment back, if the partners agreeUSUALLY FOLLOWED BY186Insurance UnderwritingRequirements Reporting997FunctionalAcknowledgment2 WHAT X12 RELEASE 008010 REQUIRESInterchange: sender and receiver IDsISA … IEAFunctional group, ID code UIGS … GETransaction set 255ST … SEHEADINGBGNBeginning Segment+ 1 optional loop, starting with:NM1DETAILRequired loop ACT · repeats many timesACTAccount IdentificationRequired loop NM1 · repeats many timesNM1Individual or Organizational NameRequired loop LX · repeats many timesLXTransaction Set Line Number+ 2 optional loops, starting with:EFIPO1Blue 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 255. Your trading partner's implementation guide adds its own requirements.
How the EDI 255 worksDiagram of the EDI 255 Underwriting Information Services. Insurance company or distributor sends it to information provider. It usually follows 267. It is usually followed by 186 and 997. Inside the ISA, GS and ST envelopes, X12 release 008010 requires, in the heading: BGN (Beginning Segment) and detail: the required ACT loop with ACT (Account Identification) and the required NM1 loop with NM1 (Individual or Organizational Name) and the required LX loop with LX (Transaction Set Line Number). 3 optional loops are listed by their first segment.How the EDI 255 worksUnderwriting Information Services: who sendsit, where it fits and what the standard marksrequired1 WHERE IT FITSUSUALLY FOLLOWS267Individual Life, Annuity and DisabilityApplicationEDI 255SENDERInsurancecompany ordistributorRECEIVERInformationprovider997 or 999 acknowledgment back, if the partnersagreeUSUALLY FOLLOWED BY186Insurance Underwriting RequirementsReporting997Functional Acknowledgment2 WHAT X12 RELEASE 008010 REQUIRESInterchange: sender and receiver IDs (ISA… IEA)Functional group, ID code UI (GS … GE)Transaction set 255 (ST … SE)HEADINGBGNBeginning Segment+ 1 optional loop, starting with:NM1DETAILRequired loop ACT · repeatsmany timesACTAccount IdentificationRequired loop NM1 · repeatsmany timesNM1Individual orOrganizational NameRequired loop LX · repeatsmany timesLXTransaction Set LineNumber+ 2 optional loops, starting with:EFIPO1Blue 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 255. Your trading partner'simplementation guide adds its own requirements.

How to read this diagram: the top row shows who sends the 255, 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 255 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

  • Ordering medical exams and lab tests
  • Ordering records such as physician statements
  • Checking the status of outstanding requirements

Where it fits in the document flow

Usually follows 267 Individual Life, Annuity and Disability Application
This document 255 Underwriting Information Services
Usually followed by 186 Insurance Underwriting Requirements Reporting997 Functional Acknowledgment

Structure

Mandatory segments in the 255 (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
  • BGN
  • NM1
  • ACT
  • LX
  • EFI
  • PO1
  • SE

Practical example

The 255 in practice

An insurer receives a life application with a large face amount. Its underwriting system sends providers 255 orders for a paramedical exam, a blood profile and an attending physician statement. A week later, a status request shows the physician statement is still pending, and the insurer informs the agent.

Implementation

Implementation considerations for the 255

  • Protect applicants' personal and health data.
  • Track every underwriting requirement to completion.
  • Use the service codes each provider supports.
  • Share status with agents to manage client expectations.

How ECOM helps

Automate the 255 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

EDI Integration

Exchange X12 and EDIFACT documents with partners and integrate them directly with your ERP.

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

Related transactions

Related healthcare and insurance documents

All 31 healthcare and insurance documents

Need help with the EDI 255?

ECOM maps, tests and monitors X12 documents for your trading partners and integrates them with your ERP.

Request a Demo Contact us