Farmers Group, Inc. Implementation Standards for EDI Documents

Transcription

1 Farmers Group, Inc Implementation Standards for EDI Documents ASC X12 Transaction Set 811 Version 3050 Consolidated Service Invoice/Statement Daily Auto Notification/Billing Created 10/04/2005 Revised 04/25/2008 AUTO811 (003050) 1 04/25/2008

2 Table of Contents 811 Format Example... 4 Introduction:... 6 Heading:... 6 Detail:... 6 Summary:... 8 Transaction Set Notes... 8 Segment: ST Transaction Set Header... 9 Segment: BIG Insurance Coverage Notification Information Segment: N1 Sender Name Segment: N1 Receiver Name Segment: HL Interested Party, Lienholder, or Lessor Detail Segment: NM1 Interested Party, Lienholder, or Lessor Name Segment: N3 Interested Party, Lienholder, or Lessor Address Segment: N4 Interested Party, Lienholder, or Lessor City, State, Zip Segment: HL Insurance Company and Agent Detail Segment: NM1 Insurance Company Name and Agent Number Segment: N2 Additional Name Information Segment: N3 Insurance Company Service Center Address Segment: N4 Insurance Company Service Center City, State, Zip Segment: PER Insurance Agent Contact Segment: HL Policy Information Detail Segment: NM1 Insured Name Segment: N3 Insured Address Segment: N4 Insured City, State, Zip Segment: IT1 Insurance Policy Information Segment: SI Transaction Purpose Segment: REF Insurance Company Reference Number Segment: REF Insurance Policy Number Segment: DTM Policy Process Date Segment: DTM Policy Effective Date Segment: HL Vehicle and Coverage Information Detail Segment: LX Section Separator Segment: VEH Vehicle Information Segment: PID Vehicle Make Segment: PID Vehicle Model and Style Segment: REF Loan or Lease Number Segment: III Loss Payable Segment: III Bodily Injury Coverage Segment: DTP Vehicle Inception Effective Date Segment: AMT Bodily Injury Per Person Limit Segment: AMT Bodily Injury Per Occurrence Limit Segment: III Property Damage Coverage Segment: DTP Vehicle Inception Effective Date Segment: AMT Property Damage Per Occurrence Coverage AUTO811 (003050) 2 04/25/2008

3 Segment: III Collision Coverage Segment: DTP Vehicle Inception Effective Date Segment: AMT Deductible Amount Segment: PCT Collision Percentage Amounts Segment: III Comprehensive Coverage Segment: DTP Vehicle Inception Effective Date Segment: AMT Deductible Amount Segment: PCT Comprehensive Percent Amount Segment: III Combined Single Limit Coverage Segment: DTP Vehicle Inception Effective Date Segment: AMT Per Occurrence Aggregate Limit Segment: HL Interested Party, Lending Institution, and Lessor Detail Segment: SLN Interested Party, Lending Institution and Lessor Information Segment: NM1 Interested Party, Lending Institution, and Lessor Name Segment: N3 Interested Party, Lending Institution, and Lessor Address Segment: N4 Interested Party, Lending Institution, and Lessor City, State, Zip Segment: TDS Total Monetary Value Summary Segment: CTT Total Number of Insurance Policies Included Segment: SE Transaction Set Trailer AUTO811 (003050) 3 04/25/2008

4 811 Format Example HEADER ST*811*0001~ Transaction Set Header BIG*080404*0001*****IC~ Insurance Coverage Notification Information N1*IN*FARMERS INSURANCE GROUP*FI* ~ Sender Name and TIN N1*57*AA LENDING INSTITUTION*FI* ~ Receiver Name and TIN DETAIL LOOP ID - HL1 HL*1**1*1~ Hierarchical Level NM1*LM*2*ABC CREDIT UNION*****FI* ~ Interested Party, Lienholder, or Lessor Detail N3*PO BOX 300*6060 MONROE ST~ Interested Party, Lienholder, or Lessor Address N4*ANYWHERE*WI*123456~ Interested Party, Lienholder, or Lessor City, State, & Zip LOOP ID - HL2 HL*2*1*2*1~ Insurance Company and Agent Detail NM1*12*2*FARMERS*****93* ~ Insurance Company Name and Agent Number N2*BUSINESS COMMUNICATION CENTER~ Additional Name Information N3*P. O. BOX 29200~ Insurance Company Service Center Address N4*SHAWNEE MISSION*KS*66201~ Insurance Company Service Center City, State, & Zip PER*AG*MICAHEL B BOLING*TE* ~ Insurance Agent Contact LOOP ID - HL4 HL*3*2*4*1~ Policy Information Detail NM1*IL*1*RICHARDS*JAMES*A~ Insured Name N3*1020 W MARION~ Insured Address N4*ANYWHERE*CA*12345~ Insured City, State, & Zip IT1**1*IP*0~ Insurance Policy Information SI*AD*08*NBS~ Transaction Purpose REF*NF*12345~ Insurance Company Reference Number REF*IG* ~ Insurance Policy Number DTM*009*070603***20~ Policy Process Date DTM*152*070718***20~ Policy Effective Date LOOP ID - HL5 HL*4*3*5*0~ Vehicle and Coverage Information Detail LX*1~ Section Separator VEH**2G1WF52E *20*03~ Vehicle Information PID*X**AD*VEHMK*CHEVROLET~ Vehicle Make PID*X**AD*VEHMD*IMPALA SEDAN~ Vehicle Model and Style REF*LD* ~ Loan or Lease Number AUTO811 (003050) 4 04/25/2008

5 LOOP ID - HL5 (Loss Payable) III*CV*LP~ Loss Payable LOOP ID - HL5 (Bodily Injury) III*CV*BI~ Bodily Injury Coverage DTP*007*D8* ~ Vehicle Inception Effective Date AMT*RD*25000~ Bodily Injury Per Person Limit AMT*PR*50000~ Bodily Injury Per Occurrence Coverage LOOP ID - HL5 (Property Damage) III*CV*PD~ Property Damage Coverage DTP*007*D6*970201~ Vehicle Inception Effective Date AMT*PR*25000~ Property Damage Per Occurrence Coverage LOOP ID - HL5 (Collision) III*CV*COLL~ Collision Coverage DTP*007*D8* ~ Vehicle Inception Effective Date AMT*PH*0~ Collision Deductible Amount PCT*PH*100~ Collision Percentage Amounts LOOP ID - HL5 (Comprehensive) III*CV*COMP~ Comprehensive Coverage DTP*007*D8* ~ Vehicle Inception Effective Date AMT*PH*0~ Comprehensive Deductible Amount PCT*PH*100~ Comprehensive Percentage Amount LOOP ID - HL5 (Combined Single Limit) III*CV*CSL~ Combined Single Limit Coverage DTP*007*D8* ~ Vehicle Inception Effective Date AMT*PT*50000~ Per Occurrence Aggregate Limit LOOP ID - HL8 HL*5*1*2*8~ Interested Party, Lending Institution, and Lessor Detail SLN*1**I*0*EA~ Interested Party, Lending Institution, and Lessor Information NM1*LE*2*GENERAL SOLUTIONS*****FI* ~ Interested Party, Lending Institution, and Lessor Name N3*1111 BROWN AVENUE~ Interested Party, Lending Institution, and Lessor Address N4*ANYWHERE*CA*12345~ Interested Party, Lending Institution, and Lessor City, State, & Zip TDS*0~ CTT*42~ SE*420*0001~ SUMMARY Total Billed Amount Total Number of Policies Transaction Set Trailer AUTO811 (003050) 5 04/25/2008

6 Functional Group ID=CI Introduction: This Implementation Guide contains the format and establishes the data contents of the Auto Daily Transaction (811) for use within the context of an Electronic Data Interchange (EDI) environment. This transaction set provides for the billing or reporting of complex and structured service invoice detail. This standard can be used by organizations who are interested in sending or receiving either consolidated or standalone invoices for service arrangements which require processing other than that done for the typical product invoice. The Consolidated Services Invoice/Statement can be used as a credit/debit memo to differentiate between payable invoice items and information-only memo items. This transaction set should not be used as a standalone notification of a credit/debit adjustment. Heading: Pos. Seg. Req. Loop Notes and No. ID Name Des. Max.Use Repeat Comments M 010 ST Transaction Set Header M 1 M 020 BIG Insurance Coverage Notification Information M 1 LOOP ID - N1SE 1 Must Use 100 N1 Sender Name O 1 LOOP ID - N1RE 1 Must Use 105 N1 Receiver Name O 1 Detail: Pos. Seg. Req. Loop Notes and No. ID Name Des. Max.Use Repeat Comments LOOP ID - HLL1 >1 M 010 HL Interested Party, Lienholder or Lessor Detail M 1 LOOP ID - NM1 1 Must Use 110 NM1 Interested Party, Lienholder, or Lessor Name O N3 Interested Party, Lienholder, or Lessor Address O N4 Interested Party, Lienholder, or Lessor City, State, Zip O 1 LOOP ID - HLL2 >1 M 010 HL Insurance Company and Agent Detail M 1 LOOP ID - NM1I 1 Must Use 110 NM1 Insurance Company Name and Agent Number O 1 Must Use 120 N2 Additional Name Information O 1 Must Use 130 N3 Insurance Company Service Center Address O 1 Must Use 140 N4 Insurance Company Service Center City, State, O PER Zip Insurance Agent Contact O >1 LOOP ID - HLL4 >1 M 010 HL Policy Information Detail M 1 LOOP ID - NM1 1 Must Use 110 NM1 Insured Name O N3 Insured Address O N4 Insured City, State, Zip O 1 AUTO811 (003050) 6 04/25/2008

7 LOOP ID - IT1 >1 Must Use 210 IT1 Insurance Policy Information O 1 Must Use 220 SI Transaction Purpose O 1 Must Use 260 REF Insurance Company Reference Number O 1 Must Use 260 REF Insurance Policy Number O 1 Must Use 270 DTM Policy Process Date O DTM Policy Effective Date O 2 LOOP ID - HLL5 >1 M 010 HL Vehicle and Coverage Information Detail M 1 LOOP ID - LX 3 Must Use 020 LX Section Separator O 1 Must Use 025 VEH Vehicle Information O 1 Must Use 040 PID Vehicle Make O 1 Must Use 040 PID Vehicle Model and Style O REF Loan or Lease Number O 1 LOOP ID - III >1 670 III Loss Payable O III Bodily Injury Coverage O DTP Vehicle Inception Effective Date O AMT Bodily Injury Per Person Limit O AMT Bodily Injury Per Occurrence Limit O III Property Damage Coverage O DTP Vehicle Inception Effective Date O AMT Personal Occurrence Coverage O III Collision Coverage O DTP Vehicle Inception Effective Date O AMT Collision Deductible Amount O PCT Collision Percentage Amounts O III Comprehensive Coverage O DTP Vehicle Inception Effective Date O AMT Comprehensive Deductible Amount O PCT Comprehensive Percent Amount O III Combined Single Limit Coverage O DTP Vehicle Inception Effective Date O AMT Per Occurrence Aggregate Limit O 1 LOOP ID - HLL8 >1 010 HL Interested Party, Lending Institution, and O 1 Lessor Detail LOOP ID SLN SLN Interested Party, Lending Institution, and O 1 Lessor Information LOOP ID - NM NM1 Interested Party, Lending Institution, and O 1 Lessor Name 550 N3 Lessor Address O N4 Lessor City, State, Zip O 1 AUTO811 (003050) 7 04/25/2008

8 Summary: Pos. Seg. Req. Loop Notes and No. ID Name Des. Max.Use Repeat Comments M 010 TDS Total Monetary Value Summary M CTT Total Number of Insurance Policies Included O 1 n1 M 120 SE Transaction Set Trailer M 1 Transaction Set Notes 1. The number of line items (CTT01) is the accumulation of the number of IT1 segments. AUTO811 (003050) 8 04/25/2008

9 Segment: ST Transaction Set Header Position: 010 Loop: Level: Heading Usage: Mandatory Purpose: To indicate the start of a transaction set and to assign a control number Syntax Notes: 1 The transaction set identifier (ST01) is used by the translation routines of the interchange partners to select the appropriate transaction set definition (e.g., 810 selects the Invoice Transaction Set). M ST Transaction Set Identifier Code M ID 3/3 Code uniquely identifying a Transaction Set 811 X12.39 Consolidated Service Invoice/Statement M ST Transaction Set Control Number M AN 4/9 Identifying control number that must be unique within the transaction set functional group assigned by the originator for a transaction set The Transaction Set Control Numbers in ST02 and SE02 must be identical. The number is assigned by the originator and must be unique within a functional group (GS-GE). AUTO811 (003050) 9 04/25/2008

10 Segment: BIG Insurance Coverage Notification Information Position: 020 Loop: Level: Heading Usage: Mandatory Purpose: To indicate the beginning of an invoice transaction set, and to transmit identifying numbers and dates Syntax Notes: 1 BIG01 is the invoice issue date. 2 BIG03 is the date assigned by the purchaser to purchase order. 3 BIG10 indicates the consolidated invoice number. When BIG07 contains code CI, BIG10 is not used. 1 BIG07 is used only to further define the type of invoice when needed. M BIG Date M DT 6/6 Date (YYMMDD) This element contains the date of file creation. M BIG02 76 Invoice Number M AN 1/22 Identifying number assigned by issuer This element will always contain a '1' BIG Transaction Type Code O ID 2/2 Code specifying the type of transaction IC Insurance Coverage Notification AUTO811 (003050) 10 04/25/2008

11 Segment: N1 Sender Name Position: 100 Loop: N1SE Optional (Must Use) Level: Heading Usage: Optional (Must Use) Purpose: To identify a party by type of organization, name, and code Syntax Notes: 1 At least one of N102 or N103 is required. 2 If either N103 or N104 is present, then the other is required. 1 This segment, used alone, provides the most efficient method of providing organizational identification. To obtain this efficiency the "ID Code" (N104) must provide a key to the table maintained by the transaction processing party. Notes: 2 N105 and N106 further define the type of entity in N101. This loop identifies the sending organization. M N Entity Identifier Code M ID 2/2 Code identifying an organizational entity, a physical location, or an individual IN Insurer >> N Name X AN 1/35 Free-form name This element will always contain Farmers Insurance Group >> N Identification Code Qualifier X ID 1/2 Code designating the system/method of code structure used for Identification Code (67) FI Federal Taxpayer's Identification Number >> N Identification Code X AN 2/20 Code identifying a party or other code This element will contain Farmers Insurance Group TIN AUTO811 (003050) 11 04/25/2008

12 Segment: N1 Receiver Name Position: 105 Loop: N1RE Optional (Must Use) Level: Heading Usage: Optional (Must Use) Purpose: To identify a party by type of organization, name, and code Syntax Notes: 1 At least one of N102 or N103 is required. 2 If either N103 or N104 is present, then the other is required. 1 This segment, used alone, provides the most efficient method of providing organizational identification. To obtain this efficiency the "ID Code" (N104) must provide a key to the table maintained by the transaction processing party. Notes: 2 N105 and N106 further define the type of entity in N101. This loop identifies the receiving organization. M N Entity Identifier Code M ID 2/2 Code identifying an organizational entity, a physical location, or an individual 57 Servicing Organization LE Lessor LM Lending Institution TV Third Party Administrator (TPA) >> N Name X AN 1/35 Free-form name This element will contain the name of the receiving organization; either an individual company or tracker. >> N Identification Code Qualifier X ID 1/2 Code designating the system/method of code structure used for Identification Code (67) FI Federal Taxpayer's Identification Number >> N Identification Code X AN 2/20 Code identifying a party or other code This element will contain the TIN of the receiving organization. AUTO811 (003050) 12 04/25/2008

13 Segment: HL Interested Party, Lienholder, or Lessor Detail Position: 010 Loop: HLL1 Mandatory Usage: Mandatory Purpose: To identify dependencies among and the content of hierarchically related groups of data segments Syntax Notes: 1 The HL segment defines a top-down/left-right ordered structure. 2 HL01 shall contain a unique alphanumeric number for each occurrence of the HL segment in the transaction set. For example, HL01 could be used to indicate the number of occurrences of the HL segment, in which case the value of HL01 would be "1" for the initial HL segment and would be incremented by one in each subsequent HL segment within the transaction. 3 HL02 identifies the hierarchical ID number of the HL segment to which the current HL segment is subordinate. 4 HL03 indicates the context of the series of segments following the current HL segment up to the next occurrence of an HL segment in the transaction. For example, HL03 is used to indicate that subsequent segments in the HL loop form a logical grouping of data referring to shipment, order, or item-level information. 5 HL04 indicates whether or not there are subordinate (or child) HL segments related to the current HL segment. Notes: Lienholder/Lessor hierarchy level. M HL Hierarchical ID Number M AN 1/12 A unique number assigned by the sender to identify a particular data segment in a hierarchical structure M HL Hierarchical Level Code M ID 1/2 Code defining the characteristic of a level in a hierarchical structure This element contains a '1' and indicates this level contains Lienholder/Leaseholder data. 1 Service/Billing Provider Code identifying the telecommunications company providing service/billing HL Hierarchical Child Code O ID 1/1 Code indicating whether if there are hierarchical child data segments subordinate to the level being described. 1 Additional Subordinate HL Data Segment in This Hierarchical Structure. AUTO811 (003050) 13 04/25/2008

14 Segment: NM1 Interested Party, Lienholder, or Lessor Name Position: 110 Loop: NM1 Optional (Must Use) Usage: Optional (Must Use) Purpose: To supply the full name of an individual or organizational entity Syntax Notes: 1 If either NM108 or NM109 is present, then the other is required. 1 NM102 qualifies NM103. M NM Entity Identifier Code M ID 2/2 Code identifying an organizational entity, a physical location, or an individual An LE will indicate an organization that only handles leases. An LM will indicate an organization that handles loans, or handles both loans and leases. LE Lessor LM Lending Institution M NM Entity Type Qualifier M ID 1/1 Code qualifying the type of entity 2 Non-Person Entity >> NM Name Last or Organization Name O AN 1/35 Individual last name or organizational name This element contains the name of the Lienholder/Leaseholder. >> NM Identification Code Qualifier X ID 1/2 Code designating the system/method of code structure used for Identification Code (67) FI Federal Taxpayer's Identification Number >> NM Identification Code X AN 2/20 Code identifying a party or other code This element contains the TIN of the Lienholder/Leaseholder. AUTO811 (003050) 14 04/25/2008

15 Segment: N3 Interested Party, Lienholder, or Lessor Address Position: 130 Loop: NM1 Optional (Must Use) Usage: Optional Purpose: To specify the location of the named party Syntax Notes: M N Address Information M AN 1/35 Address information N Address Information O AN 1/35 Address information AUTO811 (003050) 15 04/25/2008

16 Segment: N4 Interested Party, Lienholder, or Lessor City, State, Zip Position: 140 Loop: NM1 Optional (Must Use) Usage: Optional Purpose: To specify the geographic place of the named party Syntax Notes: 1 If N406 is present, then N405 is required. 1 A combination of either N401 through N404, or N405 and N406 may be adequate to specify a location. 2 N402 is required only if city name (N401) is in the USA or Canada. >> N City Name O AN 2/30 Free-form text for city name >> N State or Province Code O ID 2/2 Code (Standard State/Province) as defined by appropriate government agency >> N Postal Code O ID 3/11 Code defining international postal zone code excluding punctuation and blanks (zip code for United States) AUTO811 (003050) 16 04/25/2008

17 Segment: HL Insurance Company and Agent Detail Position: 010 Loop: HLL2 Mandatory Usage: Mandatory Purpose: To identify dependencies among and the content of hierarchically related groups of data segments Syntax Notes: 1 The HL segment defines a top-down/left-right ordered structure. 2 HL01 shall contain a unique alphanumeric number for each occurrence of the HL segment in the transaction set. For example, HL01 could be used to indicate the number of occurrences of the HL segment, in which case the value of HL01 would be "1" for the initial HL segment and would be incremented by one in each subsequent HL segment within the transaction. 3 HL02 identifies the hierarchical ID number of the HL segment to which the current HL segment is subordinate. 4 HL03 indicates the context of the series of segments following the current HL segment up to the next occurrence of an HL segment in the transaction. For example, HL03 is used to indicate that subsequent segments in the HL loop form a logical grouping of data referring to shipment, order, or item-level information. 5 HL04 indicates whether or not there are subordinate (or child) HL segments related to the current HL segment. Notes: Insurance Company Service Center hierarchy level. M HL Hierarchical ID Number M AN 1/12 A unique number assigned by the sender to identify a particular data segment in a hierarchical structure >> HL Hierarchical Parent ID Number O AN 1/12 Identification number of the next higher hierarchical data segment that the data segment being described is subordinate to This element contains the value found in the HL01 element of the parent HL level. M HL Hierarchical Level Code M ID 1/2 Code defining the characteristic of a level in a hierarchical structure This element contains a '2' and indicates this level contains Insurance Company Service Center and Agent information. 2 Billing Arrangement Code identifying a specified billing arrangement >> HL Hierarchical Child Code O ID 1/1 Code indicating whether if there are hierarchical child data segments subordinate to the level being described. 1 Additional Subordinate HL Data Segment in This Hierarchical Structure. AUTO811 (003050) 17 04/25/2008

18 Segment: NM1 Insurance Company Name and Agent Number Position: 110 Loop: NM1I Optional (Must Use) Usage: Optional (Must Use) Purpose: To supply the full name of an individual or organizational entity Syntax Notes: 1 If either NM108 or NM109 is present, then the other is required. 1 NM102 qualifies NM103. Notes: This loop provides information about the Insurance Company Service Center and Insurance Agent. If contact is required with an Agent, then please send to the address provided in this NM1 loop along with the Agent Name in the PER02 element and Agent ID Number in the NM109 element. M NM Entity Identifier Code M ID 2/2 Code identifying an organizational entity, a physical location, or an individual 12 Regional Office M NM Entity Type Qualifier M ID 1/1 Code qualifying the type of entity 2 Non-Person Entity >> NM Name Last or Organization Name O AN 1/35 Individual last name or organizational name This element has a constant value of Farmers >> NM Identification Code Qualifier X ID 1/2 Code designating the system/method of code structure used for Identification Code (67) 93 Code assigned by the organization originating the transaction set >> NM Identification Code X AN 2/20 Code identifying a party or other code This element contains the Identification Number of the Farmers Agent associated with the policy. This number must be referenced when sending data for the Agent via the Business Communications Center. AUTO811 (003050) 18 04/25/2008

19 Segment: N2 Additional Name Information Position: 120 Loop: NM1I Optional (Must Use) Usage: Optional (Must Use) Purpose: To specify additional names or those longer than 35 characters in length Syntax Notes: M N Name M AN 1/35 Free-form name This element has a constant value of Business Communications Center and is to be used as the second line of address when contacting an agent by US Mail. N Name O AN 1/35 Free-form name AUTO811 (003050) 19 04/25/2008

20 Segment: N3 Insurance Company Service Center Address Position: 130 Loop: NM1I Optional (Must Use) Usage: Optional (Must Use) Purpose: To specify the location of the named party Syntax Notes: Notes: This P. O. Box is for Auto correspondence only. M N Address Information M AN 1/35 Address information N Address Information O AN 1/35 Address information AUTO811 (003050) 20 04/25/2008

21 Segment: N4 Insurance Company Service Center City, State, Zip Position: 140 Loop: NM1I Optional (Must Use) Usage: Optional (Must Use) Purpose: To specify the geographic place of the named party Syntax Notes: 1 If N406 is present, then N405 is required. 1 A combination of either N401 through N404, or N405 and N406 may be adequate to specify a location. 2 N402 is required only if city name (N401) is in the USA or Canada. >> N City Name O AN 2/30 Free-form text for city name N State or Province Code O ID 2/2 Code (Standard State/Province) as defined by appropriate government agency N Postal Code O ID 3/11 Code defining international postal zone code excluding punctuation and blanks (zip code for United States) AUTO811 (003050) 21 04/25/2008

22 Segment: PER Insurance Agent Contact Position: 160 Loop: NM1I Optional (Must Use) Usage: Optional Max Use: >1 Purpose: To identify a person or office to whom administrative communications should be directed Syntax Notes: 1 If either PER03 or PER04 is present, then the other is required. 2 If either PER05 or PER06 is present, then the other is required. 3 If either PER07 or PER08 is present, then the other is required. Notes: This segment provides the name and phone number of the Insurance Agent associated with the policy. M PER Contact Function Code M ID 2/2 Code identifying the major duty or responsibility of the person or group named AG Agent >> PER02 93 Name O AN 1/35 Free-form name >> PER Communication Number Qualifier X ID 2/2 Code identifying the type of communication number TE Telephone >> PER Communication Number X AN 1/80 Complete communications number including country or area code when applicable This element contains the full 10 digit phone number for the policy holder s Agent. AUTO811 (003050) 22 04/25/2008

23 Segment: HL Policy Information Detail Position: 010 Loop: HLL4 Mandatory Usage: Mandatory Purpose: To identify dependencies among and the content of hierarchically related groups of data segments Syntax Notes: 1 The HL segment defines a top-down/left-right ordered structure. 2 HL01 shall contain a unique alphanumeric number for each occurrence of the HL segment in the transaction set. For example, HL01 could be used to indicate the number of occurrences of the HL segment, in which case the value of HL01 would be "1" for the initial HL segment and would be incremented by one in each subsequent HL segment within the transaction. 3 HL02 identifies the hierarchical ID number of the HL segment to which the current HL segment is subordinate. 4 HL03 indicates the context of the series of segments following the current HL segment up to the next occurrence of an HL segment in the transaction. For example, HL03 is used to indicate that subsequent segments in the HL loop form a logical grouping of data referring to shipment, order, or item-level information. 5 HL04 indicates whether or not there are subordinate (or child) HL segments related to the current HL segment. Notes: Policy and Insured hierarchy level. M HL Hierarchical ID Number M AN 1/12 A unique number assigned by the sender to identify a particular data segment in a hierarchical structure >> HL Hierarchical Parent ID Number O AN 1/12 Identification number of the next higher hierarchical data segment that the data segment being described is subordinate to This element contains the value found in the HL01 element of the parent HL level. M HL Hierarchical Level Code M ID 1/2 Code defining the characteristic of a level in a hierarchical structure This element contains a '4' and indicates this level contains Policy and Insured data. 4 Group Code identifying a group of charges on the bill HL Hierarchical Child Code O ID 1/1 Code indicating whether if there are hierarchical child data segments subordinate to the level being described. 1 Additional Subordinate HL Data Segment in This Hierarchical Structure. AUTO811 (003050) 23 04/25/2008

24 Segment: NM1 Insured Name Position: 110 Loop: NM1 Optional (Must Use) Usage: Optional (Must Use) Purpose: To supply the full name of an individual or organizational entity Syntax Notes: 1 If either NM108 or NM109 is present, then the other is required. 1 NM102 qualifies NM103. M NM Entity Identifier Code M ID 2/2 Code identifying an organizational entity, a physical location, or an individual IL Insured or Subscriber M NM Entity Type Qualifier M ID 1/1 Code qualifying the type of entity 1 Person 2 Non-Person Entity >> NM Name Last or Organization Name O AN 1/35 Individual last name or organizational name NM Name First O AN 1/25 Individual first name NM Name Middle O AN 1/25 Individual middle name or initial AUTO811 (003050) 24 04/25/2008

25 Segment: N3 Insured Address Position: 130 Loop: NM1 Optional (Must Use) Usage: Optional Purpose: To specify the location of the named party Syntax Notes: M N Address Information M AN 1/35 Address information AUTO811 (003050) 25 04/25/2008

26 Segment: N4 Insured City, State, Zip Position: 140 Loop: NM1 Optional (Must Use) Usage: Optional Purpose: To specify the geographic place of the named party Syntax Notes: 1 If N406 is present, then N405 is required. 1 A combination of either N401 through N404, or N405 and N406 may be adequate to specify a location. 2 N402 is required only if city name (N401) is in the USA or Canada. >> N City Name O AN 2/30 Free-form text for city name >> N State or Province Code O ID 2/2 Code (Standard State/Province) as defined by appropriate government agency >> N Postal Code O ID 3/11 Code defining international postal zone code excluding punctuation and blanks (zip code for United States) AUTO811 (003050) 26 04/25/2008

27 Segment: IT1 Insurance Policy Information Position: 210 Loop: IT1 Optional (Must Use) Usage: Optional (Must Use) Purpose: To specify the basic and most frequently used line item data for the invoice and related transactions Syntax Notes: 1 If any of IT102 IT103 or IT104 is present, then all are required. 2 If either IT106 or IT107 is present, then the other is required. 3 If either IT108 or IT109 is present, then the other is required. 4 If either IT110 or IT111 is present, then the other is required. 5 If either IT112 or IT113 is present, then the other is required. 6 If either IT114 or IT115 is present, then the other is required. 7 If either IT116 or IT117 is present, then the other is required. 8 If either IT118 or IT119 is present, then the other is required. 9 If either IT120 or IT121 is present, then the other is required. 10 If either IT122 or IT123 is present, then the other is required. 11 If either IT124 or IT125 is present, then the other is required. 1 IT101 is the purchase order line item identification. 1 Element 235/234 combinations should be interpreted to include products and/or services. See the Data Dictionary for a complete list of ID's. 2 IT106 through IT125 provides for ten (10) different product/service ID's for each item. For example: Case, Color, Drawing No., UPC No., ISBN No., Model No., SKU. >> IT Quantity Invoiced X R 1/10 Number of units invoiced (supplier units) This element will always contain a '1' >> IT Unit or Basis for Measurement Code X ID 2/2 Code specifying the units in which a value is being expressed, or manner in which a measurement has been taken IP Insurance Policy An individual insurance contract M IT Unit Price M R 1/17 Price per unit of product, service, commodity, etc. As this transaction is for notification only, the unit price will always be 0 AUTO811 (003050) 27 04/25/2008

28 Segment: SI Transaction Purpose Position: 220 Loop: IT1 Optional (Must Use) Usage: Optional (Must Use) Purpose: To specify service characteristic data Syntax Notes: 1 If either SI04 or SI05 is present, then the other is required. 2 If either SI06 or SI07 is present, then the other is required. 3 If either SI08 or SI09 is present, then the other is required. 4 If either SI10 or SI11 is present, then the other is required. 5 If either SI12 or SI13 is present, then the other is required. 6 If either SI14 or SI15 is present, then the other is required. 7 If either SI16 or SI17 is present, then the other is required. 8 If either SI18 or SI19 is present, then the other is required. 9 If either SI20 or SI21 is present, then the other is required. 1 SI01 defines the source for each of the service characteristics qualifiers. Notes: This segment identifies what action this transaction is reporting. M SI Agency Qualifier Code M ID 2/2 Code identifying the agency assigning the code values AD Agency Company Organization for Research and Development (ACORD) M SI Service Characteristics Qualifier M ID 2/2 Code from an industry code list qualifying the type of service characteristics This element will contain a value of '08' indicating that a Policy Transaction Type code follows. 08 Policy Transaction Code M SI Product/Service ID M AN 1/40 Identifying number for a product or service Below are the only four codes used by Farmers. A policy change (PCH) will be used to indicate all changes not specifically included in the list below. Renewals are not sent as all policies are continuous until cancelled, either by request or for non-payment. This transaction will not provide the reason for cancellation. NBS New Business PCH Policy Change REI Reinstatement XLC Cancellation AUTO811 (003050) 28 04/25/2008

29 Segment: REF Insurance Company Reference Number Position: 260 Loop: IT1 Optional (Must Use) Usage: Optional (Must Use) Purpose: To specify identifying numbers. Syntax Notes: 1 At least one of REF02 or REF03 is required. Notes: This segment contains the NAIC number for the Insurance Company. Farmers uses a master NAIC of '21652' for all Auto EDI transactions. M REF Reference Number Qualifier M ID 2/2 Code qualifying the Reference Number. NF National Association of Insurance Commissioners (NAIC) Code A unique number assigned to each insurance company TJ Federal Taxpayer's Identification Number >> REF Reference Number X AN 1/30 Reference number or identification number as defined for a particular Transaction Set, or as specified by the Reference Number Qualifier. AUTO811 (003050) 29 04/25/2008

30 Segment: REF Insurance Policy Number Position: 260 Loop: IT1 Optional (Must Use) Usage: Optional (Must Use) Purpose: To specify identifying numbers. Syntax Notes: 1 At least one of REF02 or REF03 is required. Notes: This segment provides the Farmers Policy Number. M REF Reference Number Qualifier M ID 2/2 Code qualifying the Reference Number. IG Insurance Policy Number >> REF Reference Number X AN 1/30 Reference number or identification number as defined for a particular Transaction Set, or as specified by the Reference Number Qualifier. AUTO811 (003050) 30 04/25/2008

31 Segment: DTM Policy Process Date Position: 270 Loop: IT1 Optional (Must Use) Usage: Optional (Must Use) Purpose: To specify pertinent dates and times Syntax Notes: 1 At least one of DTM02 DTM03 or DTM06 is required. 2 If either DTM06 or DTM07 is present, then the other is required. Notes: This segment provides the Processing date. As notification records are created the same day as processing, this date will always be the same as the BIG01 date. M DTM Date/Time Qualifier M ID 3/3 Code specifying type of date or time, or both date and time 009 Process >> DTM Date X DT 6/6 Date (YYMMDD) DTM Century O N0 2/2 The first two characters in the designation of the year (CCYY) AUTO811 (003050) 31 04/25/2008

32 Segment: DTM Policy Effective Date Position: 270 Loop: IT1 Optional (Must Use) Usage: Optional Max Use: 2 Purpose: To specify pertinent dates and times Syntax Notes: 1 At least one of DTM02 DTM03 or DTM06 is required. 2 If either DTM06 or DTM07 is present, then the other is required. Notes: Please refer to the following Segment 'SI' on page 28 for 'SI' Code Definitions. For Lienholder Removal: Element DTM01 Code '177' will be sent along with Element SI03 code 'PCH' For New Business and Reinstatement: Element DTM01 Code '007' will be sent along with Element SI03 codes 'NBS' or 'REI' For Policy Cancellation: Element DTM01 Code '152' will be sent along with Element DTM01 Code '117' to indicate the effective date of the cancellation and Element SI03 code 'XLC' M DTM Date/Time Qualifier M ID 3/3 Code specifying type of date or time, or both date and time FARMERS Definition of Codes: New Business and/or Reinstatement Legal Cancellation for Lienholder / Lessor 177 Insurer s Date (Only if Policy is Cancelled) or the Legal date of Lienholder / Lessor Interest removal 007 Effective 152 Effective Date of Change Date on which the change went into effect 177 Cancellation Date on which the coverage or service is no longer in force DTM Date X DT 6/6 Date (YYMMDD) DTM Century O N0 2/2 The first two characters in the designation of the year (CCYY) AUTO811 (003050) 32 04/25/2008

33 Segment: HL Vehicle and Coverage Information Detail Position: 010 Loop: HLL5 Mandatory Usage: Mandatory Purpose: To identify dependencies among and the content of hierarchically related groups of data segments Syntax Notes: 1 The HL segment defines a top-down/left-right ordered structure. 2 HL01 shall contain a unique alphanumeric number for each occurrence of the HL segment in the transaction set. For example, HL01 could be used to indicate the number of occurrences of the HL segment, in which case the value of HL01 would be "1" for the initial HL segment and would be incremented by one in each subsequent HL segment within the transaction. 3 HL02 identifies the hierarchical ID number of the HL segment to which the current HL segment is subordinate. 4 HL03 indicates the context of the series of segments following the current HL segment up to the next occurrence of an HL segment in the transaction. For example, HL03 is used to indicate that subsequent segments in the HL loop form a logical grouping of data referring to shipment, order, or item-level information. 5 HL04 indicates whether or not there are subordinate (or child) HL segments related to the current HL segment. Notes: Vehicle information hierarchy level. M HL Hierarchical ID Number M AN 1/12 A unique number assigned by the sender to identify a particular data segment in a hierarchical structure >> HL Hierarchical Parent ID Number O AN 1/12 Identification number of the next higher hierarchical data segment that the data segment being described is subordinate to This element contains the value found in the HL01 element of the parent HL level. M HL Hierarchical Level Code M ID 1/2 Code defining the characteristic of a level in a hierarchical structure This element contains a '5' and indicates this level contains Vehicle data. 5 Category Code identifying the sub-division of the group HL Hierarchical Child Code O ID 1/1 Code indicating whether if there are hierarchical child data segments subordinate to the level being described. 0 No Subordinate HL Segment in This Hierarchical Structure. 1 Additional Subordinate HL Data Segment in This Hierarchical Structure. AUTO811 (003050) 33 04/25/2008

34 Segment: LX Section Separator Position: 020 Loop: LX Optional (Must Use) Usage: Optional (Must Use) Purpose: To reference a line number in a transaction set Syntax Notes: M LX Assigned Number M N0 1/6 Number assigned for differentiation within a transaction set This element will always contain a '1' as Farmers only covers 1 vehicle per 11 digit policy number. AUTO811 (003050) 34 04/25/2008

35 Segment: VEH Vehicle Information Position: 025 Loop: LX Optional (Must Use) Usage: Optional (Must Use) Purpose: To provide descriptions that identify a specific vehicle Syntax Notes: 1 If VEH03 is present, then VEH04 is required. 2 If VEH05 is present, then at least one of VEH06 or VEH08 is required. 3 If VEH06 is present, then VEH05 is required. 4 If VEH07 is present, then both VEH05 and VEH06 are required. 5 If VEH08 is present, then VEH05 is required. 1 VEH05 applies to VEH06, VEH07, and VEH08. 2 VEH06 is the vehicle make. 3 VEH07 is the vehicle model. 4 VEH08 is the vehicle style. 5 VEH09 is the length of a vehicle measured in feet. 6 VEH10 is the vehicle reference number. 7 VEH11 is the vehicle registration state or province. 8 VEH12 is used to identify a territory as defined by trading partners. 9 VEH13 is the Used Car Indicator. A value of ``Y'' indicates the vehicle is a used vehicle. A value of ``N'' indicates the vehicle is a new vehicle. A value of ``U'' indicating unknown cannot be used. 10 VEH14 is the original cost of the vehicle when it was new (i.e., OCN - original cost new). 11 VEH15 is the Vehicle Altered Indicator. A value of ``Y'' indicates the vehicle was altered. A value of ``N'' indicates the vehicle was not altered. The value of ``U'' indicating unknown cannot be used. 12 VEH16 is the value of alterations for a vehicle. Notes: This segment will contain the VIN and year of the vehicle. VEH Assigned Number O N0 1/6 Number assigned for differentiation within a transaction set >> VEH Vehicle Identification Number O AN 1/25 Unique identification number stamped on the vehicle by the manufacturer >> VEH Century O N0 2/2 The first two characters in the designation of the year (CCYY) M VEH Year Within Century M N0 2/2 The last two characters in the designation of the year (CCYY) AUTO811 (003050) 35 04/25/2008

36 Segment: PID Vehicle Make Position: 040 Loop: LX Optional (Must Use) Usage: Optional (Must Use) Purpose: To describe a product or process in coded or free-form format Syntax Notes: 1 If PID04 is present, then PID03 is required. 2 At least one of PID04 or PID05 is required. 3 If PID07 is present, then PID03 is required. 4 If PID08 is present, then PID03 is required. 1 Use PID03 to indicate the organization that publishes the code list being referred to. 2 PID04 should be used for industry-specific product description codes. 3 PID08 describes the physical characteristics of the product identified in PID04. A ``Y'' indicates that the specified attribute applies to this item. A ``N'' indicates it does not apply. Any other value is indeterminate. 1 If PID01 = ``F'', then PID05 is used. If PID01 = ``S'', then PID04 is used. If PID01 = ``X'', then both PID04 and PID05 are used. 2 Use PID06 when necessary to refer to the product surface or layer being described in the segment. Notes: 3 PID07 specifies the individual code list of the agency specified in PID03. This segment provides the make of the Vehicle. M PID Item Description Type M ID 1/1 Code indicating the format of a description X Semi-structured (Code and Text) PID Agency Qualifier Code X ID 2/2 Code identifying the agency assigning the code values AD Agency Company Organization for Research and Development (ACORD) PID Product Description Code X AN 1/12 A code from an industry code list which provides specific data about a product characteristic VEHMK Vehicle Make PID Description X AN 1/80 A free-form description to clarify the related data elements and their content AUTO811 (003050) 36 04/25/2008

37 Segment: PID Vehicle Model and Style Position: 040 Loop: LX Optional (Must Use) Usage: Optional (Must Use) Purpose: To describe a product or process in coded or free-form format Syntax Notes: 1 If PID04 is present, then PID03 is required. 2 At least one of PID04 or PID05 is required. 3 If PID07 is present, then PID03 is required. 4 If PID08 is present, then PID03 is required. 1 Use PID03 to indicate the organization that publishes the code list being referred to. 2 PID04 should be used for industry-specific product description codes. 3 PID08 describes the physical characteristics of the product identified in PID04. A ``Y'' indicates that the specified attribute applies to this item. A ``N'' indicates it does not apply. Any other value is indeterminate. 1 If PID01 = ``F'', then PID05 is used. If PID01 = ``S'', then PID04 is used. If PID01 = ``X'', then both PID04 and PID05 are used. 2 Use PID06 when necessary to refer to the product surface or layer being described in the segment. Notes: 3 PID07 specifies the individual code list of the agency specified in PID03. This segment provides the model of the Vehicle. M PID Item Description Type M ID 1/1 Code indicating the format of a description S Structured (From Industry Code List) X Semi-structured (Code and Text) PID Agency Qualifier Code X ID 2/2 Code identifying the agency assigning the code values AD Agency Company Organization for Research and Development (ACORD) PID Product Description Code X AN 1/12 A code from an industry code list which provides specific data about a product characteristic VEHMD Vehicle Model PID Description X AN 1/80 A free-form description to clarify the related data elements and their content AUTO811 (003050) 37 04/25/2008

38 Segment: REF Loan or Lease Number Position: 050 Loop: LX Optional (Must Use) Usage: Optional Purpose: To specify identifying numbers. Syntax Notes: 1 At least one of REF02 or REF03 is required. Notes: This segment will contain the Lease / Loan Number. M REF Reference Number Qualifier M ID 2/2 Code qualifying the Reference Number. LC Lease Number LD Loan Number >> REF Reference Number X AN 1/30 Reference number or identification number as defined for a particular Transaction Set, or as specified by the Reference Number Qualifier. AUTO811 (003050) 38 04/25/2008

39 Segment: III Loss Payable Position: 670 Loop: III Optional Usage: Optional Purpose: To report information Syntax Notes: 1 If either III01 or III02 is present, then the other is required. 2 If III03 is present, then at least one of III04 or III05 is required. 1 III03 is used to categorize III04. Notes: There will be one 'III' segment for each type of coverage being reported. If there are limits or Deductible amounts, then an 'AMT' or a PCT segment will be provided. An AMT segment will be sent when the deductible is a fixed dollar amount. A PCT segment will be sent when the deductible is a fixed percentage of the loss. If there is an 'III' segment but no 'AMT' segment, then there is coverage without specific limits or deductibles. If there is coverage for Actual Cash Value then there will be a deductible 'AMT' segment with a value of 0 If the policy has a Loss Payable clause, there will be an 'III' segment with a value of 'LP' and no corresponding AMT or DTP segments. If there is no 'III' segment for a specific type of coverage, then the policy does not provide that type of coverage at this time. >> III Code List Qualifier Code X ID 1/3 Code identifying a specific industry code list CV Coverage Code List >> III Industry Code X AN 1/20 Code indicating a code from a specific industry code list BI Bodily Injury Liability COLL Collision Coverage COMP Comprehensive Fire/Theft CSL Combined single Limit Liability LP Loss Payable Clause MEDPM Medical Payments PD Property Damage Single Limit TL Towing and Labor UMIPD Uninsured Motorist - Prop. Damage UMISP Uninsured Motorist - Liability UNDPD Underinsured Motorist - Prop. Damage UNDSP Underinsured Motorist - Liability AUTO811 (003050) 39 04/25/2008

40 Segment: III Bodily Injury Coverage Position: 675 Loop: III Optional Usage: Optional Purpose: To report information Syntax Notes: 1 If either III01 or III02 is present, then the other is required. 2 If III03 is present, then at least one of III04 or III05 is required. 1 III03 is used to categorize III04. III Code List Qualifier Code X ID 1/3 Code identifying a specific industry code list Refer to Data Element Dictionary for acceptable code values. III Industry Code X AN 1/20 Code indicating a code from a specific industry code list AUTO811 (003050) 40 04/25/2008

41 Segment: DTP Vehicle Inception Effective Date Position: 680 Loop: III Optional Usage: Optional Purpose: To specify any or all of a date, a time, or a time period Syntax Notes: 1 DTP02 is the date or time or period format that will appear in DTP03. Notes: This segment provides the date the Vehicle was added to the Policy. M DTP Date/Time Qualifier M ID 3/3 Code specifying type of date or time, or both date and time Refer to Data Element Dictionary for acceptable code values. M DTP Date Time Period Format Qualifier M ID 2/3 Code indicating the date format, time format, or date and time format Refer to Data Element Dictionary for acceptable code values. M DTP Date Time Period M AN 1/35 Expression of a date, a time, or range of dates, times, or dates and times AUTO811 (003050) 41 04/25/2008

42 Segment: AMT Bodily Injury Per Person Limit Position: 690 Loop: III Optional Usage: Optional Purpose: To indicate the total monetary amount Syntax Notes: Notes: If there is only one 'AMT' segment then there is a single aggregate limit or deductible. If there are no 'AMT' segments, but there is an 'III - Loss Payable' segment, then the coverage is provided without variable limits or deductible. M AMT Amount Qualifier Code M ID 1/2 Code to qualify amount PH Per Occurrence Deductible PR Per Occurrence Limit PT Per Occurrence Aggregate Limit RD Per Person Limit SB Stated Amount M AMT Monetary Amount M R 1/15 Monetary amount All amounts are in whole dollars. A '0' amount will only appear if there is Actual Cash Value coverage. AUTO811 (003050) 42 04/25/2008

43 Segment: AMT Bodily Injury Per Occurrence Limit Position: 695 Loop: III Optional Usage: Optional Purpose: To indicate the total monetary amount Syntax Notes: M AMT Amount Qualifier Code M ID 1/2 Code to qualify amount Refer to Data Element Dictionary for acceptable code values. M AMT Monetary Amount M R 1/15 Monetary amount AMT Credit/Debit Flag Code O ID 1/1 Code indicating whether amount is a credit or debit Refer to Data Element Dictionary for acceptable code values. AUTO811 (003050) 43 04/25/2008

44 Segment: III Property Damage Coverage Position: 698 Loop: III Optional Usage: Optional Purpose: To report information Syntax Notes: 1 If either III01 or III02 is present, then the other is required. 2 If III03 is present, then at least one of III04 or III05 is required. 1 III03 is used to categorize III04. III Code List Qualifier Code X ID 1/3 Code identifying a specific industry code list Refer to Data Element Dictionary for acceptable code values. III Industry Code X AN 1/20 Code indicating a code from a specific industry code list AUTO811 (003050) 44 04/25/2008