ISO Services Properties, Inc., 2015 ISO Confidential/Proprietary Information Version 5.7.2

XML Manual Version 5.7.2

OCTOBER 2015 I N S U R A N C E S E R V I C E S O F F I C E, I N C.

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Use of a term in this publication shall not be construed as granting any right, title, or interest in or to any patent, trademark, copyright, or other right in or to the information. All

information contained in this publication remains the property of ISO or the applicable third party.

THE SYSTEM DESCRIBED IN THIS DOCUMENT IS CONFIDENTIAL AND PROPRIETARY TO INSURANCE SERVICES OFFICE, INC. (ISO) OR ITS LICENSORS.

NO PART OF THIS PUBLICATION MAY BE REPRODUCED, COPIED, SOLD, DISTRIBUTED IN ANY MANNER OR BY ANY MEANS, WITHOUT THE EXPRESS

WRITTEN PERMISSION FROM ISO.

The terms and conditions governing the licensing and use of ISO systems consist solely of those set forth in the written contracts between ISO and its customers.

ISO makes no warranty of any kind with regard to this material, including, but not limited to, the implied warranties of merchantability and fitness for a particular purpose. ISO shall

not be liable for errors contained herein or for damages in connection with the furnishing, performance, or use of this material. Information in this publication is subject to change

without notice.

NOTICE: © ISO Properties, Inc. 2015. This Documentation includes proprietary trade secrets and confidential information of ISO.

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TABLE OF CONTENTS

INTRODUCTION .......................................................................................................................................................... 1 Structure/Purpose of This Guide ............................................................................................................................. 1 About ISO’s XML Initiative ....................................................................................................................................... 1 About ISO ClaimSearch ........................................................................................................................................... 1 Convenient Report Filing .......................................................................................................................................... 2 Fast, Reliable Search Reports ................................................................................................................................. 2 Fulfillment of State Reporting Obligations ............................................................................................................... 3 Protection of Data ..................................................................................................................................................... 3 Summary ................................................................................................................................................................... 3

Summary of Changes ................................................................................................................................................ 4 Version 5.7.2 Changes ............................................................................................................................................. 4 Version 5.7 Changes ................................................................................................................................................ 4 Version 5.6 Changes ................................................................................................................................................ 6 Version 5.5 Changes ................................................................................................................................................ 6

ISO ClaimSearch Universal Format Operating Rules ........................................................................................ 10 Subscriber Obligations ........................................................................................................................................... 10 Reinsurance and Excess Policies Companies ..................................................................................................... 10 Fronted Policies ...................................................................................................................................................... 10 States of Licensing ................................................................................................................................................. 10 Audit and Verification .............................................................................................................................................. 10 System Use ............................................................................................................................................................. 10 Lines of Business.................................................................................................................................................... 11 Reporting Office Code Assignment ....................................................................................................................... 11 Insuring Company / Agency IDs ............................................................................................................................ 11 Requirements for Claims Administrators and Adjusters ....................................................................................... 11

Electronic Transmission Of Claims ...................................................................................................................... 12 Telecommunication Options (Input) ...................................................................................................................... 12

Web Services ...................................................................................................................................................... 12 HTTPS POST ..................................................................................................................................................... 12

Telecommunication Options (Output) ................................................................................................................... 12 HTTPS POST ..................................................................................................................................................... 12

Testing Procedures .................................................................................................................................................. 13 Production Requirements ....................................................................................................................................... 14 ACORD Definition of XML Terms........................................................................................................................... 15

Definition of Terms.................................................................................................................................................. 15 Data Type Definitions ............................................................................................................................................. 16 Date and Time Formats ......................................................................................................................................... 17

System Input (Request) ........................................................................................................................................... 18 Introduction ............................................................................................................................................................. 18 Initial Reports .......................................................................................................................................................... 18

Summary of XML Request Aggregates in Schema Order ............................................................................... 19 Replacement/ Update Requests ........................................................................................................................... 37

Replacement Claims .......................................................................................................................................... 37 Update Claims .................................................................................................................................................... 38 Re-Search Request ............................................................................................................................................ 45 Changing Key Field Information ........................................................................................................................ 47

Special Programming Notes .................................................................................................................................. 49 ClaimInvestigationAddRq/Rs RqUID ................................................................................................................. 49 Claim Level Reporting Vs. Exposure Level Reporting ..................................................................................... 49 Data Editing Rules .............................................................................................................................................. 49 Deleting Information in Fields ............................................................................................................................. 51 Entering “Invalid” Names .................................................................................................................................... 51 IMPORTANT NOTICE REGARDING UPDATING CLAIMS VIA THE CLAIMSEARCH WEBSITE ............. 51

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IMPORTANT NOTICE REGARDING UPDATE REQUESTS AND CMS MEDICARE REPORTING ......... 52 Miscellaneous Text Fields <RemarkText> ........................................................................................................ 52 Minimizing Replacement and Update Rejections ............................................................................................. 52 Multiple Vehicle Reporting ................................................................................................................................. 52 No Coverage/ No Loss Type ............................................................................................................................. 53 Physical Risk, Mailing Address, and SIU Claim Level Elements ..................................................................... 53 Replacement and Re-Search Records from "Other Offices" ........................................................................... 54 Searchable Elements ......................................................................................................................................... 54

System Output (Receipt and Response) .............................................................................................................. 56 Receipt (Acknowledgement) .................................................................................................................................. 56 XML Format Error ................................................................................................................................................... 57 AgencyId Error ........................................................................................................................................................ 57 XML Reject Response ........................................................................................................................................... 58 XML Success Response ........................................................................................................................................ 60

Summary of XML Success Response Aggregates in Schema Order ............................................................. 60 Automatic Update Reports ..................................................................................................................................... 65 Vehicle Recovery Reports ..................................................................................................................................... 65 Impound Update Reports ....................................................................................................................................... 66 VIN Quality Control ................................................................................................................................................. 66 Stylesheets.............................................................................................................................................................. 67 Disclaimer Notice .................................................................................................................................................... 67

ENTITIES .................................................................................................................................................................... 68 ACORD Document Request Entity (%ACORDREQ) .......................................................................................... 68 Claims Investigation Information Entity (%CLAIMSINVESTIGATIONINFO) ...................................................... 68 Claims Message Request Information Entity (%CLAIMSMSGRQINFO) ........................................................... 69 Claims Message Response Information Entity (%CLAIMSMSGRSINFO) ......................................................... 69 Currency (%Currency) ........................................................................................................................................... 70 Duration (%DURATION) ........................................................................................................................................ 70 Measurement (%MEASUREMENT) ..................................................................................................................... 70 Property Casualty Policy Entity (%PCPOLICY) .................................................................................................... 70

WRAPPER AGGREGATES ..................................................................................................................................... 71 ACORD Aggregate <ACORD> ............................................................................................................................. 71 Signon Aggregates ................................................................................................................................................. 71 Claims Service ........................................................................................................................................................ 72

Request <ClaimsSvcRq> ................................................................................................................................... 72 Claims Investigation Submission Messages ......................................................................................................... 72

Request <ClaimInvestigationAddRq> ............................................................................................................... 72 Response <ClaimInvestigationAddRs> ............................................................................................................ 73

Miscellaneous Aggregates ..................................................................................................................................... 74 AGGREGATES .......................................................................................................................................................... 75

Additional Information <com.iso_AddInfo> ........................................................................................................... 75 Additional Coverage Information <com.iso_AddCovInfo> ................................................................................... 75 Additional Matches Aggregate <AdditionalMatchInfo> ........................................................................................ 75 Address Aggregate <Addr> ................................................................................................................................... 76 Airbag Information Aggregate <AirbagInfo> ......................................................................................................... 76 Adjuster Party Aggregate <AdjusterParty> ........................................................................................................... 76 Adjuster Party Information Aggregate <AdjusterPartyInfo> ................................................................................. 77 Appraiser Activity Information <AppraiserActivityInfo> ......................................................................................... 77 Auto Investigation Information Aggregate <AutoInvestigationInfo> ..................................................................... 77 Auto Loss Information Aggregate <AutoLossInfo> ............................................................................................... 78 Catastrophe Aggregate <Catastrophe> ................................................................................................................ 79 Claims Driver Information Aggregate <ClaimsDriverInfo> ................................................................................... 79 Claims Injured Information Aggregate <ClaimsInjuredInfo> ................................................................................ 79 Claims Injury Aggregate <ClaimsInjury> ............................................................................................................... 80 Claims Occurrence Aggregate <ClaimsOccurrence> .......................................................................................... 80 Claims Party Aggregate <ClaimsParty> ............................................................................................................... 82

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Claims Party Information Aggregate <ClaimsPartyInfo>...................................................................................... 83 Claims Party Relationship Aggregate <ClaimsPartyRelationship> ..................................................................... 84 Claims Party Vehicle Information <com.iso_ClaimsPartyVehInfo> ..................................................................... 84 Claims Payment Aggregate <ClaimsPayment> ................................................................................................... 84 Claims Payment Coverage Info Aggregate <ClaimsPaymentCovInfo> ............................................................. 85 Claims Reported Aggregate <ClaimsReported> .................................................................................................. 85 Claims Subject of Insurance Information Aggregate <ClaimsSubjectInsuranceInfo> ........................................ 85 Commercial Name Aggregate <CommlName> ................................................................................................... 86 Communications Aggregate <Communications> ................................................................................................. 86 Coverage Information 1 <com.iso_CovInfo1> ...................................................................................................... 86 Coverage Information 1 <com.iso_CovInfo1> (cont.) .......................................................................................... 87 Fill with zeroes if no-fault limit has not been reached/exhausted or if this is a WC or Liability claim. ................ 87 Coverage Information 2 <com.iso_CovInfo2> ...................................................................................................... 88 Driver’s License Aggregate <DriversLicense> ...................................................................................................... 89 Email Information Aggregate <EmailInfo> ............................................................................................................ 89 Employee Information Aggregate <EmployeeInfo> ............................................................................................. 89 Event Information Aggregate <EventInfo> ............................................................................................................ 89 General Party Information Aggregate <GeneralPartyInfo> .................................................................................. 90 Item Definition Aggregate <ItemDefinition> .......................................................................................................... 90 Item Id Information Aggregate <ItemIdInfo> ......................................................................................................... 91 Item Information Aggregate <ItemInfo> ................................................................................................................ 91 Investigation Information Aggregate <InvestigationInfo> ..................................................................................... 91 Key Reason Information Aggregate <com.iso_KeyReasonInfo> ........................................................................ 92 Litigation Information Aggregate <LitigationInfo> ................................................................................................. 92 Match Details Aggregate <MatchDetails> ............................................................................................................. 93 Match Information Aggregate <MatchInfo>........................................................................................................... 93 Match Reason Information Aggregate <MatchReasonInfo> ............................................................................... 94 Miscellaneous Party Aggregate <MiscParty> ....................................................................................................... 94 Miscellaneous Party Information Aggregate <MiscPartyInfo> ............................................................................. 94 Name Information Aggregate <NameInfo> ........................................................................................................... 94 Non Tax Identity Aggregate <NonTaxIdentity> .................................................................................................... 95 Party Investigation Information Aggregate <PartyInvestigationInfo> ................................................................... 95 Person Information Aggregate <PersonInfo> ....................................................................................................... 95 Personal Name Aggregate <PersonName> ......................................................................................................... 96 Personal Vehicle Information Aggregate <PersVehInfo> .................................................................................... 96 Phone Information Aggregate <PhoneInfo> ......................................................................................................... 96 Policy Aggregate <Policy> ..................................................................................................................................... 96 Property Loss Information Aggregate <PropertyLossInfo> .................................................................................. 96 Property Schedule Aggregate <PropertySchedule> ............................................................................................ 97 Recovery Information Aggregate <RecoveryInfo> ............................................................................................... 98 Registration Aggregate <Registration> ................................................................................................................. 98 Salvage Information Aggregate <SalvageInfo> .................................................................................................... 99 Special Investigator Aggregate <com.iso_SIUInfo> ............................................................................................. 99 Special Investigation Details Aggregate <com.iso_SIUParty> ......................................................................... 100 Special Investigator Phone Information Aggregate <com.iso_SIUPhoneInfo> ............................................... 101 Summary Reason Information Aggregate <com.iso_SumReasonInfo> .......................................................... 101 Tax Identity Aggregate <TaxIdentity> ................................................................................................................ 102 Vehicle Information Aggregate <VehInfo> ......................................................................................................... 102 Vehicle Theft Verification Aggregate <com.iso_TheftVerification> ................................................................... 102 Watercraft Aggregate <Watercraft> ................................................................................................................... 103 Workers Compensation Loss Information Aggregate <WorkCompLossInfo> ................................................. 103

Update Request Aggregates ............................................................................................................................... 104 Claims Update Aggregate <com.iso_Update> .................................................................................................. 104 Claims Update Original Fields Aggregate <com.iso_OriginalFields>............................................................... 104 Claims Update Original Key Fields Aggregate <com.iso_KeyFields> ............................................................. 104

Additional Services ............................................................................................................................................... 105

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Standard Additional Services .............................................................................................................................. 106 ACCOUNT MANAGEMENT REPORTS ....................................................................................................... 106 MANDATORY – STATUTORY REPORTING FOR THE INDUSTRY ........................................................ 107 NATIONAL HIGHWAY AND TRAFFIC SAFETY ADMINISTRATION (NHTSA) VEHICLE RECALL ....... 109 NATIONAL MOTOR VEHICLE TITLE INFORMATION SYSTEM (NMVTIS) ............................................. 110

Optional Additional Services ............................................................................................................................... 112 APPEND-DS

SM ................................................................................................................................................ 112

CHILD SUPPORT ENFORCEMENT AGENCY (CSLN/OCSE) REPORTING .......................................... 114 CLAIMDIRECTOR

SM ....................................................................................................................................... 115

MARINE INDEX BUREAU CLAIMS .............................................................................................................. 118 MEDICAID REPORTING SERVICE (MAIS) ................................................................................................. 119 MEDICARE SECONDARY PAYER REPORTING SERVICE (CMS) ......................................................... 120 OFAC COMPLIANCE SOLUTIONS .............................................................................................................. 122

Additional Services Aggregates .......................................................................................................................... 124 Append-DS Aggregate <com.iso_AppendDS> ............................................................................................. 124 NHTSA Vehicle Recall Aggregate <com.iso_VehRecall> ............................................................................ 124 ClaimDirector Rules Aggregate <com.iso_ClaimDirectorRules> ................................................................. 124 Claims Handling Characteristics Aggregate <com.iso_ClaimsHandlingCharacteristics> ........................... 125 Claims Party Scored Match Aggregate <com.iso_ScoredMatch> ............................................................... 125 Claims Score Report Aggregate <com.iso_ClaimScoreReport> ................................................................. 125 Claims Scoring Information Aggregate <com.iso_ClaimsScoringInfo> ....................................................... 126 CMS Warning Aggregate <com.iso_CMS> ................................................................................................... 126

Transitioning from Universal Format ................................................................................................................. 127 Benefits of Transitioning to XML Platform .......................................................................................................... 127 Programming Differences between Universal Format and XML Format ......................................................... 127

Batch Processing vs. Individual Claim Processing ........................................................................................ 127 Universal Format to XML Format Conversions ................................................................................................. 127

UF to XML Conversion Process for Non-Guidewire Customers .................................................................. 128 UF to XML Conversion Process for Guidewire Claim Center Customers .................................................... 128

Testing the Universal Format to XML Format Conversion Process ................................................................. 129 Conversion Process Best Practices ................................................................................................................... 129

Answers to Frequently Asked Questions ......................................................................................................... 131 Appendix A – Code Lists ..................................................................................................................................... 133 Appendix B – Policy, Coverage, and Loss Types ............................................................................................ 152

Reporting Claims to ClaimSearch under Personal Combination Policies ........................................................ 153 Policy, Coverage and Loss Determinations for Medicare Secondary Payer Section 111 Reporting ............. 153

ClaimsInjuredInfo Combinations ..................................................................................................................... 154 AutoLossInfo Combinations ............................................................................................................................ 171 PropertyLossInfo/ClaimsSubjectInsuranceInfo Combinations ...................................................................... 174 PropertyLossInfo/Watercraft Combinations ................................................................................................... 177 PropertyLossInfo/ItemInfo Combinations ....................................................................................................... 183

Appendix C – Field and Relationship Edits ...................................................................................................... 186 Entering “Invalid” Names ..................................................................................................................................... 187 Increased Record Limit ....................................................................................................................................... 187 Error Code Definitions ......................................................................................................................................... 188

Appendix D – Role Codes .................................................................................................................................... 193 Involved Party Role Codes (ClaimsPartyRoleCd - ISOUS) .............................................................................. 193 Other Party Role Codes (ClaimsPartyRole - ACORD) ..................................................................................... 193 Service Provider Role Codes (ISOUS) .............................................................................................................. 195 Additional Claimant Role Codes for Medicare Section 111 Reporting ............................................................. 195 Legal Representative Role Codes for Medicare Section 111 Reporting .......................................................... 196

Appendix E – Claims Payment and Status Reporting Rules ......................................................................... 197 Claims Payment Reporting Rules ...................................................................................................................... 197 Claims Status Reporting Rules ........................................................................................................................... 199

Who to Call ............................................................................................................................................................. 200

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INTRODUCTION

Structure/Purpose of This Guide

The ISO ClaimSearch®

system is a valuable information resource for first and third-party claim reporting and retrieval. This manual on electronic transmission of claims through XML Format is intended to assist Information Systems personnel with the proper formatting of files and records for submission of claims to, and receipt of, matching reports from ISO ClaimSearch in XML. The document details the relationship between the ACORD specification and ISO ClaimSearch. All of the data elements that can be submitted to ISO ClaimSearch are noted in this manual. All of the data elements in, and benefits of Universal Format are represented in the XML transmission, although the names may differ somewhat. About ISO’s XML Initiative

ISO has recognized the inherent value of XML, including the substantial savings that can be recognized by utilizing XML. In an effort to assist our members in maximizing the use of ISO ClaimSearch, ISO is pleased to be able to accept and transmit data in an XML Format. ISO’s goal in preparing to accept XML was to ensure that users who wished to utilize ISO’s Universal Format would be able to send XML in place of Universal Format but still retain the benefits of Universal Format submission. ISO has recognized that in addition to facilitating the transmission of data, XML can be best utilized when standardized XML is used. To ensure that our members fully realize the benefits of utilizing XML, ISO therefore initiated the formation of a Claims Investigation Working Group facilitated by ACORD. The working group has developed an XML Claims Investigation message which was accepted as an industry standard in November of 2002. All of the elements of ISO’s Universal Format are represented in the claims investigation transaction, which means that members who wish to transmit data to ISO ClaimSearch in an XML Format will be able to utilize an industry standard sponsored by ACORD. ISO has therefore succeeded in allowing our members to utilize a standard XML message in place of Universal Format while still retaining all the benefits of Universal Format submission to ISO ClaimSearch. Some ISO-specific data elements could not be included in the specification (namely those data elements for ISO’s scoring products). However, ACORD allows for the use of Service Provider Extensions (SPX), within the context of the standard specification. An SPX will allow a user to submit company-specific XML within a standard message. The SPX developed by ISO is included in this manual. ISO looks forward to continuing to provide ISO ClaimSearch users with improved transmission methods. About ISO ClaimSearch

ISO ClaimSearch is the property/casualty insurance industry's first and only comprehensive system for improving claims processing and fighting fraud.

Each year, participating insurers and other organizations submit tens of millions of reports on individual insurance claims. ISO stores those reports in a single database that helps insurers, self-insurers, law enforcement agencies, and state fraud bureaus detect and prevent fraud, evaluate risk, and process meritorious claims.

ISO ClaimSearch furnishes the essential data for researching prior-loss histories, identifying claims patterns, and detecting suspect claims. ISO's Internet interface lets users conduct broad and flexible searches of the data.

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Through additional reporting elements in XML Format, ISO ClaimSearch furnishes the data that every company needs to protect itself against paying questionable or possibly fraudulent claims. The XML format approach to claim reporting provides a single point of entry for multi-line claim input and a report delivery system that equips claims personnel with essential data for researching prior loss histories, identifying claims patterns, and detecting potentially fraudulent claims. The ISO ClaimSearch database now contains over 1 billion claims. The ISO ClaimSearch database now holds information on over 1 billion claims, including over 33 million legacy property claims, 150 million legacy casualty claims, 452 million legacy automobile claims, and 342 million Universal Format claims. The System receives 254 million submissions each year. Claim reports transmitted to ISO ClaimSearch are processed and matched against millions of other claims in the database. If the system finds a "match" (i.e. a similar claim submitted to the system by another customer), a report is returned to help identify claim patterns which may indicate fraudulent or suspicious activity or duplicate coverage. Through ISO ClaimSearch XML Format, customers handling a claim in any line can (depending on their level of participation) discover whether the claimant has had a claims history or has filed duplicate claims across multiple lines of insurance. Prior to ISO ClaimSearch XML Format, users of the various systems had to report claims to three separate systems (Index, PILR, and Auto) in three proprietary formats. Each line-of-business-specific claim submitted would generate a search of the corresponding database and produce match reports limited to that line of business (auto, property, or casualty). With claim submissions under ISO ClaimSearch XML Format, the system automatically performs cross-line searches for claims in other lines of business for those companies participating in the additional lines. For example, a report of an auto claim automatically includes the existence of other claims for an individual, possibly alerting users to a pattern of losses that may warrant additional investigation. Under the XML Format, data elements common to all claim types are reported by aggregate, with line-of-business specific information in their own aggregates. These enhancements are a step toward better integration of the systems for users of what will be a singular reporting and inquiry system. In addition to changing the data transmission, users of the systems are being asked to provide more data elements on claims and to report new lines of business. Through member task groups, ISO worked closely with insurers to define the additional data elements and lines of business that should be included in ISO ClaimSearch. These recommendations for expanded data and reporting have been included in XML Format to increase the value of the data available via the ISO ClaimSearch system for claims personnel as well as for SIU’s. All claims should be submitted to the system. Complete reporting by all subscribers enhances the value of the ISO ClaimSearch database. Convenient Report Filing

Participating companies file reports to the ISO ClaimSearch database on all automobile, property, and liability claims. Reporting under XML takes place electronically through system-to-system communication. Fast, Reliable Search Reports

Initial claim reports are added to the ISO ClaimSearch database. Each claim report (for example, auto, property or casualty or a combination thereof) received by the ISO ClaimSearch system initiates a search against the database. A message containing all claim records that appear to be attributable to the claimant in the initial report is quickly returned to the requesting subscriber. Approximately one out of every two searches reveals that the claimant has had previous bodily injury or automobile related claim activity, or duplicate insurance within the past five years. On average, four previous histories are found for those claimants with injury claims histories. One out of every two searches results in prior property losses being found.

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Fulfillment of State Reporting Obligations

Fire loss reporting for specified first-party property claims satisfies statutory reporting in twenty-two states. Fire losses are automatically reported to Alaska, Arizona, Delaware, Florida, Georgia, Idaho, Illinois, Kansas, Kentucky, Maryland, Massachusetts, Michigan, Minnesota, Nebraska, New Hampshire, New Mexico, New York, North Dakota, Tennessee, Vermont, Washington, and West Virginia. The states that require submission of auto data include New York, New Jersey, California, Connecticut, Massachusetts, and Rhode Island. Protection of Data

ISO protects the ISO ClaimSearch database against unauthorized access. For the protection of its customers, ISO ClaimSearch is operated and maintained according to the requirements of federal and state privacy laws. Individuals are allowed full disclosure of any data regarding their own claims that the database may contain. If a consumer requests information regarding data maintained in ISO ClaimSearch, subscribers should refer the individual to ISO. After receipt of a written request, the information will be released directly to the requester. If the consumer disputes the claim information in writing, ISO will initiate an investigation with the submitting subscriber, who under system rules must assist in the investigation. Pending the outcome of that investigation, ISO will then change or delete the claim or add a Statement of Dispute (provided by the consumer) to the claim record. The information maintained in the ISO ClaimSearch system is confidential and is not made available to the general public. Unauthorized individuals or companies that do not subscribe to the various segments of the ISO ClaimSearch database will not receive claim information unless ISO receives written consent from the individual in question (as in the situation outlined in the preceding paragraph) or is required by court order. Summary

The ISO ClaimSearch database is the vital and dependable information resource that every company needs during the claim investigation and settlement process. To increase the ability for fraud detection, claim submissions under ISO ClaimSearch XML Format are automatically searched across the property, auto, and casualty lines of business for those companies participating in the additional lines. It is managed and operated under stringent privacy rules to protect the confidentiality and integrity of the data.

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SUMMARY OF CHANGES

Every version of the User Manual includes any new or updated elements or processes that have been added to the system since the last version as a matter of course. However each manual also contains many corrections and clarifications to make the manual a little bit better and easier to understand based on the requests and commentary of users like you. Therefore, not every possible change is listed in the summary below. If you should find a discrepancy or a section that is not clear, please feel free to bring it to our attention so that we may improve it in our next version for future users. Version 5.7.2 Changes

Schema changes Based on customer requests, ISO ClaimSearch has made some changes in hierarchy of the two new fields which were introduced in Version 5.7 of XML User Manual. Statement of Dispute – <com.iso_NewSOD> on echo and matches will now be returned under <ClaimsParty> aggregate in order to allow Statement of Dispute to be reported for each Involved party if necessary. For Echo: ClaimInvestigationAddRs/ClaimsParty/com.iso_NewSOD For Match: ClaimInvestigationAddRs/MatchDetails/ClaimsParty/com.iso_NewSOD Email Address for Adjuster Party information – a reference ID (idref) has been created to allow a flexibility to report a separate email address if the claim contains multiple coverages. <EmailInfo idref="ClaimsInjury-xx">

CMS Warning Code changes CMS Warnings – the description for two of CMS Warnings codes (<CMSWarningCd>) 21 and 22 were changed. Please refer to Appendix A (page 146).

Version 5.7 Changes

Accident and Health Long Term Care Coverage/Loss Type Addition ISO ClaimSearch has added a new Long Term Care Coverage and Loss Type under the Accident and Health Policy Type. These are now listed in Appendix B under the Other section.

Policy Coverage Loss CMS

ACHE ACCIDENT & HEALTH LGTC LONG TERM CARE

LGTC LONG TERM CARE

Accident and Health Accidental Death and Dismemberment Coverage/Loss Type Addition

ISO ClaimSearch has added a new Accidental Death and Dismemberment Coverage and Loss Type under the Accident and Health Policy Type. These are now listed in Appendix B under the Other section.

Policy Coverage Loss CMS

ACHE ACCIDENT & HEALTH ACDD ACCIDENTAL DEATH AND DISMEMBERMENT

ACDD ACCIDENTAL DEATH AND DISMEMBERMENT

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New Data Elements will be added in the 4

th Quarter of 2015

A few new data elements were added to XML format to make it compatible with the Universal Format

records changes in which all claims are processed. All elements below are optional, but the more data provided to the system by a large number of users benefits the system and industry as a whole. These changes are anticipated to be available in the Acceptance environment in October for testing and in Production by the end of the year. Further announcements will be communicated regarding these changes as they are migrated to our testing and production environments. Email Address for Adjuster Party information – For coverage information, ClaimSearch has added the

ability to report the e-mail address for the adjuster in order to allow you to more easily communicate with other carriers on questionable losses.

Email Address for Adjuster Party – <ClaimInvestigationAddRq><AdjusterParty>< GeneralPartyInfo><Communications><EmailInfo><EmailAddr>. The email address submitted in this field will be associated with the Adjuster Party the <AdjusterParty> references.

Driver’s License Class for Claim Party information – A new data element was added to the existing

Extra information for Involved Party and AKA aggregates to allow for driver’s class to be entered. See Appendix A.

Driver’s License Class for Claim Party information – <ClaimInvestigationAddRq></ClaimsParty> <ClaimsDriverInfo><DriversLicense><LicenseClassCd>. Valid codes and detailed descriptions for <LicenseClassCd>can be found in Appendix A section.

CAT Code for Claim Level information – If your company is a member of ISO’s Property Claim Service

(PCS) please be advised that beginning January 1, 2016, any new catastrophes should be reported under the new element <com.iso_NewCATCd> vs. the current <CatastropheCd> element. If you are reporting a catastrophe prior to 2016, you should use the existing CAT Code <ClaimsOccurrence>/<

Catastrophe>/< CatastropheCd>. If you are reporting a catastrophe that occurs beginning in 2016, you should use the new CAT code.

CAT Code for Claim Level information – <ClaimInvestigationAddRq><ClaimOccurance> <Catastrophe><com.iso_NewCATCd>.

ERISA Claim Indicator for Claim Party information – A new data element was added to the existing

casualty information aggregate to indicate if the claim is an ERISA claim. Texas permits employers to opt out of its workers’ compensation system and instead set up alternative plans that cover employees’ on-the-job injuries. These plans typically provide no-fault benefits and are governed by the Employee Retirement Income Security Act (“ERISA”). The ERISA indicator should be used on an Accident/Health Policy Type with Coverage/loss types of Health.

ERISA Claim Indicator for Claim Party information – <ClaimInvestigationAddRq><ClaimParty> <ClaimsInjuredInfo><ClaimsInjury><com.iso_ERISAClmInd>.

Additional Loss Description for Claim Level information –We have determined that most companies capture loss descriptions that are usually longer that the loss description field length we allowed for current loss description and as a result, often the information reported to ClaimSearch is truncated. If your company’s loss descriptions are longer than 50 bytes, you may report the description on the new <com.iso_NewExtLossDesc> element which will allow for 200 bytes rather than use the description on the <IncidentDesc> element (<ClaimsOccurrence>/< IncidentDesc>).

Extended Loss Description for Claim Level indormation – <ClaimInvestigationAddRq> <ClaimOccurance><com.iso_NewExtLossDesc>.

Statement of Dispute – A new record was added to the echo and matches to display a Statement of Dispute if reported by citizen. If a Citizen disputes a claim and the insurer is unwilling to remove or alter the claim to the citizens’ satisfaction, the citizen may request that a statement be added to that claim. Currently if there is a dispute on the claim, ClaimSearch passes an indicator to you in <com.iso_StatementOfDisputeInd>. With this change, in addition to passing the indicator, we will now pass a description of dispute in new element <com.iso_NewSOD>.

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Non - Standard VIN Validation – In order for a vehicle to qualify for NMVTIS reporting, standard VINs (17digit VINs) must either pass the VIN validation edit or pass the Check Digit edits (in elements <ValidVINInd> and <com.iso_NMVTISCheckInd>). If non-standard VIN (more than or less than 17 digits) is submitted, the VIN will automatically fail the edits, but will still be sent to NMVTIS if the vehicle meets the other NMVTIS qualifications. A new indicator is being provided in new element <com.iso_NonStdVINVerify> to indicate

if a non-standard VIN was submitted in which case you may ignore the fact that you received a message stating that the VIN fails the edits.

Medicare Section 111 – ICD-10 Reminder The XML schema already provided the ability to report ICD-10 Diagnostic Codes and Cause of Injury codes. This is just a reminder that all claims reported to CMS with a Date of Incident on or after 10/1/15 must be reported with ICD-10 codes instead of ICD-9 codes. Below are the existing tags for reporting ICD-10 codes: ICD-10 codes – ClaimInvestigationAddRq/ com.iso_AddCovInfo/ com.iso_CovInfo1/ com.iso_ICD10Cd ICD-10 Alleged Cause of Injury – ClaimInvestigationAddRq/ com.iso_AddCovInfo/ com.iso_CovInfo2/

com.iso_ICD10CauseOfInjuryCd – This field is an optional CMS field, however if submitted it must be valid. Alleged Cause of Injury (V, W, X, Y) codes can only be used when reporting ICD-10 codes. Updated CMS Warning Messages (CMSWarningCd) – in particular, Warning Codes 22-41 and 73-82.

Version 5.6 Changes

Homeowners Workers Compensation Policy/Coverage/Loss Type Addition Based on customer request, ISO ClaimSearch is now pleased to offer Workers’ Compensation Coverage and Loss Types as an option under the Personal Property Homeowners Policy Type. This should enhance the reporting of these claims as well as aid in the Medicare Reporting requirements. These are now listed in Appendix B under the Workers Compensation section.

Policy Coverage Loss CMS

PPHO PERSONAL PROPERTY HOMEOWNERS

WCIL INDEMNITY WCIL INDEMNITY W

WCLL LIABILITY WCLL LIABILITY W

WCML MEDICAL WCML MEDICAL W

Transitioning from Universal Format

Guidance was added to this version of the manual for customers making the transition from ISO ClaimSearch’s Universal Format application.

Version 5.5 Changes

Claim Level Reporting Vs. Exposure Level Reporting ISO ClaimSearch designed our Universal Format system as a means to get away from exposure level reporting. It was named “Universal” as it combined all the elements of a single claim into a single transaction to ISO, allowing for multiple claimants and coverages to be reported at once. The system is designed to search multiple searchable fields for each claimant on the claim and bring back a single match report that contains the matches for all claims. When there is activity on the system that matches against your claim, ISO ClaimSearch provides an automatic update to your system for the claim in its entirety. When you update a portion of the claim, the system will search against the claim in its entirety (default), or only on the parties that you indicate. With exposure level reporting, ISO ClaimSearch has found several issues that have adversely impacted customers who choose to do this type of reporting. The first is that while the claimant and coverage might change from claim to claim, the overall claim details and insured information do not. Therefore it is often the

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case that the different exposures create matches against themselves. This creates extra “noise” for the adjusters as they are required to sort through their own company’s claims to find other matching claims. If there are enough matches in the system and a particular claimant maxes out at 25 claims, they could be missing out on matches if their own company’s reports are filling up many of the 25 slots per claimant. When an automatic update matches against the insured, every exposure on the claim will receive an automatic update. Again this creates extra “noise” for the adjusters as they will have multiples of the same report for a single claim. For many companies that have chosen to go this route, ISO ClaimSearch has received many complaints from users about the excessive reports they are receiving. Unfortunately, it is a case of “system working as designed” and we have to direct the users back to their own development team to state that this is not what they had in mind. Finally when other companies match against your claims, or are using fraud investigation tools, an insured with 5 claimants on the claim has now moved from a single claim with 5 claimants, to appearing as if the insured has 5 separate claims against the policy. This throws off any claims scoring products as the computer systems will count it as multiple claims indicating that your insured is more fraudulent than they really are, possibly flagging them in the companies you match against. For all of these reasons, ISO ClaimSearch is no longer allowing customers to move into Production with exposure level reporting. If a company is already reporting exposure level reporting, they will be asked to change to claim level reporting during their next system upgrade.

Basic Service Enhancements

ISO ClaimSearch recently undertook a project to add elements to the system that users have requested as useful tools for their claims handling. Therefore we have added two new searchable elements, four indicators that can be used to set flags or triggers, and one new service provider role code. All the elements below are optional, but the more data provided to the system by a large number of users benefits the system and industry as a whole. Email Address for Involved Party, Service Provider, or AKA information – Email addresses can now be

added as a searchable field through Claims Reporting (either via system-to-system or website data entry). It has not yet been added to the Claims Inquiry tool, but is intended to be included in a future enhancement. Please see the “Searchable Elements” section for further information on the rules associated with this search.

Email Address for Involved Party or Service Provider - <com.iso_SIUParty><Communications> <EmailInfo><EmailAddr>. The email address submitted in this field will be associated with the ClaimsParty the <com.iso_SIUParty> references. Use “ClaimsPartyRef” for an Involved Party or “ClaimsParty2Ref” for a Service Provider.

Email Address for AKA information – <ClaimsParty><GeneralPartyInfo><Communications> <EmailInfo><EmailAddr>. This email address will only be saved if the Role Code on the claim is “Alias”. All other email addresses must be submitted as part of the <com.iso_SIUParty> aggregate.

Driver’s License Number and State for AKA information – Previously Driver’s License information could

only be reported as part of the Involved Party information. Now, customers have the ability to add AKA Driver’s License as well. Note – This field will only be searched if the AKA information is associated with a searchable Involved Party.

Driver’s License for AKA information – <ClaimsParty><ClaimsDriverInfo><DriversLicense> <DriversLicenseNumber>

Driver’s License for AKA information – <ClaimsParty><ClaimsDriverInfo><DriversLicense> <StateProvCd>

Driver’s License State for AKA information – <ClaimsParty><ClaimsDriverInfo><DriversLicense> Web

Overlay Indicator – Claims that were submitted via system-to-system and subsequently updated via the website follow a different set of rules regarding how data may be changed or removed from a claim. This indicator was added to the raw Response XML file as a system-flag that information returned in the echo portion of the claim may be different than what was submitted on the request. This has not been added to the Stylesheets.

Web Overlay Indicator – <ClaimInvestigationAddRs><com.iso_WebOverlayInd> (right after <MatchReportTypeCd>) – This element will display a “Y” value if the claim has been touched on the ClaimSearch website or will not be present if not touched. Please ensure that your system can

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either accept or ignore this new element in the Response. Date of First Doctor’s Visit After Accident – While this is a date field and not an indicator per se, it may

be used as an indicator to flag discrepancies in claims. If your company is signed up for the ClaimDirector Service, please be advised that this is a new ClaimDirector Important Optional Field.

Date of First Doctor’s Visit After Accident – <ClaimsParty><PersonInfo><com.iso_1stDoctorDt> This element is restricted to specific Service Provider role codes. Please see Appendix D – Role Codes for further information.

Content Theft Type Indicator – This element is created in relation to CargoNet. If populated, it will

enhance the CargoNet database. It indicates whether the contents were stolen from a Retail Store (R) or Cargo/Truck (C). Loss Type must equal “THFT”.

Content Theft Type Indicator – <PropertyLossInfo><com.iso_ContentTheftInd> Total Loss NMVTIS Check Indicator – Claims marked as Total Loss for NMVTIS reporting purposes

may still be sent to NMVTIS if they fail the overall VIN check, but the Check Digit value is correct.

Total Loss NMVTIS Check – <InvestigationInfo><com.iso_NMVTISCheckInd>. This element will display “E” if the VIN failed VIN validation, but passed check digit validation to indicate that it is eligible to be sent as long as all other NMVTIS criteria is met. For all other conditions, this indicator will not be present.

Hit and Run Indicator – This element has been present on the Request schema for a long time. It has

now been included in the Response file and the stylesheets.

Hit and Run Indicator – <ClaimsOccurrence><com.iso_HitAndRunInd> = Y/N/not present Estimate Amount – This element has been corrected from an input only to a full round-trip element on

the MV02 record.

Estimate Amount – <ClaimsOccurrence><ProbableIncurredAmt> (with idref to AutoLossInfo) New Service Provider Role Code – Billing Company “BL” may be reported as a Service Provider Role

Code. Additional Service Added – Medicaid Reporting Service (MAIS)

ISO ClaimSearch developed the ISO ClaimSearch Medicaid Reporting Service in 2012 in response to the Medicaid reporting and verification requirements in Rhode Island. The Rhode Island Executive Office of Health and Human Services (RI EOHHS) passed Article 11 as part of Title 27, chapter 57.1 — the Medical Assistance Intercept Act. Article 11 requires all insurers that write workers compensation or liability policies in Rhode Island to participate in a data match program called the Medical Assistance Intercept System (MAIS). MAIS recovers and intercepts Medicaid payments issued on behalf of Medicaid recipients if an insurer pays on a claim.

Insurers, self-insurers, and third party administrators can participate in the Medicaid Reporting Service on an individual state-by-state basis or through automatic enrollment as additional states allow ISO’s solution to fulfill regulatory reporting requirements.

Additional Services Updated Append-DS offers multiple levels of service that individual companies can choose from. This section of

the manual has been updated to include a short description of the different levels. Child Support Enforcement Agency (CSEA) description has been updated to reflect current statutory

requirements and system processing rules. ClaimDirector description has been updated to reflect current system processing rules.

Additional Service Removed – Electronic Data Recorder (EDR) Service This service is no longer being offered by ISO ClaimSearch. The element <com.iso_EDRInd> should no longer return and the description has been removed from the User Manual.

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ISO CLAIMSEARCH BASIC SERVICE CORRECTIONS AND CLARIFICATIONS Corrected copyright statement on page ii to “Use of a term in this publication shall NOT be construed...” Clarified <RecoveryStatusCd> codelistrefs on Responses. Clarified rules for <com.iso_SIUParty> record in Summary of Initial Record Types. Clarified VIN requirements on <AutoLossInfo> in reference to salvaged vehicles and NMVTIS reporting. Changed Schema file name to reflect that the .xsd file is for “Request Only”. Updated wording on <PropertyLossInfo> to indicate this can now be reported multiple times. Clarified <ClaimsSvcRq> rules, ACORD allows repeating. ISO only accepts first instance. Corrected <com.iso_StopQueryForCMS> to <com.iso_StopCMSQuery> to match schema. Corrected <LitigationInfo> <PlaintiffRef> to <PlaintiffRefs>.

MEDICARE SECONDARY PAYER REPORTING SERVICE (CMS) CHANGES ICD-10 codes - <com.iso_AddCovInfo><com.iso_CovInfo1><com.iso_ICD10Cd> – These fields had

previously been marked as “future use”. These words were removed and programming added to capture data submitted in these fields.

ICD-10 Alleged Cause of Injury - <com.iso_AddCovInfo><com.iso_CovInfo2> <com.iso_ICD10CauseOfInjuryCd> - This field is an optional CMS field, however if submitted it must be valid. Alleged Cause of Injury (E) codes can only be used when reporting ICD-9 codes. Alleged Cause of Injury (V, W, X, Y) codes can only be used when reporting ICD-10 codes.

Updated CMS Warning Messages – in particular, Warning Codes 22-41 and 73-82. Updated Appendix A – Policy/Coverage/Loss codes for Ocean Marine (COMR). Added Medical Payments

(MPAY) as an available coverage with Medical Payments (MPAY) and Bodily Injury (BODI) as available loss types. These can be used for ORM reporting on Medicare Eligible claims.

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ISO CLAIMSEARCH UNIVERSAL FORMAT OPERATING RULES

Subscriber Obligations

Subscribers have an obligation to provide accurate information. In those states where required by law, subscribers also have an obligation to inform the insured that claim information will be reported to the ISO ClaimSearch database, and that claim information may be released to other subscribers that have a permissible purpose. Subscribers should request information only in connection with an active claim and should disclose any such information only to persons directly involved in the investigation and settlement of the claim. Reinsurance and Excess Policies Companies

These companies should report only claims resulting under policies where direct written premium is involved. For instance, if an insurance company is administering a self-insured plan for which an excess policy has also been issued, only claims affecting that excess policy should be reported to ISO ClaimSearch for that carrier. Reporting the underlying loss should take place under the self-insured. Fronted Policies

A self-insured company should report claims to ISO ClaimSearch under an Insuring Company ID Number for either a self-insured category or claims administrator category. An insurance company writing a fronted plan cannot lend its unique Insuring Company ID to self-insured clients or their administrators. States of Licensing

An insurance carrier should not submit reports from a state in which the carrier is not licensed to do business since ISO ClaimSearch assessments are based upon direct written premium volume. Audit and Verification

ISO reserves the right to audit and verify submissions to the system. All customers must comply with such procedures pursuant to the ISO Privacy and Security Policy and the ISO ClaimSearch Participation Agreement. System Use

Information obtained from ISO ClaimSearch shall be used exclusively by the subscriber, its adjusters, and investigators. The information shall not be used for purposes of insurance underwriting (include ratemaking, risk classification, actuarial calculations, identification of prospective customers, or reclassification of insureds), policy cancellation or renewal, establishing or stabilizing claims payment levels, pre- or post-employment screening, granting of credit or any similar purpose. The customer assumes all responsibility for assuring that its adjusters and investigators use ISO ClaimSearch only for the foregoing authorized purposes. The customer shall designate which of its employees and representatives will be authorized to receive claims reports and other information from the system.

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Lines of Business

Since the thoroughness of a database search depends on the timely reporting, accuracy, and extent of information furnished; a claim report should be submitted for all claims as soon as possible after the claim is reported to the carrier. Each report type should contain as much data as possible for submission to increase the probability of locating any prior claims history. To ensure completeness of the database, all claims in the following lines may be submitted: All First Party Property Errors & Omissions All Theft Losses Fidelity & Surety All Third Party Property General Liability Auto Physical Damage Homeowner's Liability Auto/Medical Payments Livestock Automobile Liability Medical Payments Aviation Ocean Marine Directors and Officers Personal Injury Protection Disability Workers' Compensation Employment Practices Reporting Office Code Assignment

The establishment of reporting offices and authorized submitting agencies to submit reports to the ISO ClaimSearch database on behalf of subscribing members is subject to the approval of ISO. The home office of the Subscriber Company must notify ISO Customer Support, in writing, of office openings, closings, or changes of address. Insuring Company / Agency IDs

ISO will provide 9-character alphanumeric codes to companies to utilize for their electronic reporting. This is known varyingly as the Customer Code, Subscriber Code, Member Code, Company Code or Office Code.

The Insuring Company ID <AgencyId> indicates the location of each reporting office. All claims should be reported at an office level (i.e. the last 5 positions of the code should NOT be zero filled.) In order to process reports and provide timely responses, ISO Customer Support must be informed of office openings, closings, address, and personnel changes. It is strongly recommended (and encouraged), that a designated representative of your company periodically reviews and updates the list of reporting locations for your company. NOTE - If a Request is submitted where the <AgencyId> is invalid, a Response cannot be sent from the ISO System as we use this field to identify the company and office a claim is being sent from and which post-back URL to return it to. Requirements for Claims Administrators and Adjusters

Claims Administrators and Adjusters reporting on behalf of a self-insured or insurance company are to use the Insuring Company Code of the participating company. Under no circumstances is an administrator, adjuster, or other company to use the code of a company that does not insure or administer the risk involved in the loss.

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ELECTRONIC TRANSMISSION OF CLAIMS

To facilitate the direct transmission of this information and the return of match reports in the most efficient manner, the system supports two methods for exchanging XML-based ISO ClaimSearch transactions with ISO. Since there are many different platforms and programming languages that can be used for the creation of XML data, ISO ClaimSearch does not provide documentation on how to submit and receive via either method. If members have questions on how to apply these telecommunication methods, most answers can be found on the public internet. Telecommunication Options (Input)

In order to submit and receive data from ISO ClaimSearch in XML, members must have a valid ISO ClaimSearch ID and password. Members must also establish a post-back URL for the receipt of match reports and must provide ISO with a range of the IP addresses that the member will be transmitting from.

Web Services

Web services provide the ability for applications to interact with others through XML-based messaging over the Internet. In the case of this particular application, XML and XML-based technologies are actually used to transport the XML-based ClaimSearch transactions. The technologies are based on industry standards and are not the property of any particular vendor. (See the XML Connectivity Letter.doc for further information.)

HTTPS POST

The utilization of HTTPS POST command, which have been in use since the inception of the World Wide Web, is the more traditional approach. In this particular case, the POST from the member will trigger the transmission of one or more XML-based claim submissions (Request) to the ISO server and, on return, a synchronous POST will be sent by ISO to the “posting” server as a Receipt or notification of an XML Format Error. (See the XML Connectivity Letter.doc for further information.) Telecommunication Options (Output)

ISO ClaimSearch can accept Web Services for the input of claims (member to ISO). ISO ClaimSearch cannot transmit returns (ISO to member) using Web Services. Our current programming only allows for HTTPS Post when transmitting returns.

HTTPS POST

ISO ClaimSearch transmits response information in a separate asynchronous POST by ISO ClaimSearch to the post-back URL specified by the Member Company. Customers are requested to program to expect variable, “txtMatch”, in the Response transmission from ISO. The XML string in the Response will begin as: txtMatch=<ClaimInvestigationAddRs>. The Response will also contain a <MsgStatusCd> of “Success” or “Failure” to indicate whether the claim passed or failed ISO ClaimSearch field edits. If the claim does not pass, then an XML Data Error will be passed back indicating the reasons for rejection. If the claim successfully passes the edits, then the member’s claim and any matching claim information will also be contained within the Response. Members may take the raw XML Response and program their systems to use the information according to their business needs. This may include, but is not limited to, directly updating the members claim system, diary an adjuster, creating and distributing a printed report, and more. Any questions regarding the telecommunications should be discussed early in the development process as the answers may have bearing on the programming of transmissions. Further information can be found in the XML Connectivity Letter.doc or contact the ISO ClaimSearch Database Development Group at ClaimSearchDatabaseDevelopment@iso.com to discuss the above information in greater detail.

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TESTING PROCEDURES

To ensure proper formatting and efficient use of the ISO ClaimSearch XML Format System, all new XML member companies will participate in testing before going "live." The test procedure includes the following: Member or Vendor will submit the XML Connectivity Letter.doc form to ISO ClaimSearch 3 weeks in

advance of expected testing date. ISO ClaimSearch will create member profile in test environment, including firewall rules and a post-back

URL. Note – Creating firewall rules may take up to 2 weeks due to ISO’s change management process. Testing Communications - Member/Vendor will send/receive data to ensure that both parties have a

successful connection. Testing XML File Format – Each transmission is required to first pass the security clearance check. Then

the transmission is checked to ensure that XML formatting standards are followed in the creation of the file. The file will not be sent on to the field contents validation if the XML file is not well formed. If the file passes the first two checks, then the file is sent through a conversion step to convert data into the formats used to store the information in our database. If information is in the wrong format or id/idrefs do not match correctly, then an error will also be returned. An XML Format Error message will be sent as a synchronous response with a <MsgStatus> of “Rejected” to the customer’s outgoing IPA. If the XML file format is valid, then a synchronous Receipt will be returned to the customer’s outgoing IPA. No claims data is sent in the Receipt, just <MsgStatus> with status of “Response Pending.” The claim will move on to validating the fields and relationships.

Testing Data – Field and relationship validation will be performed. Fields will be checked for accuracy and

completeness as well as compared to other relational fields (i.e., loss type / coverage type). The Response will be sent to the customer’s incoming post-back URL when the system is ready (usually within minutes). The <MsgStatus> will indicate whether the Request resulted in a “Success” or was “Rejected.” A successful response will include an echo of the initial claim and any matching claims. A rejection response (XML Data Error) will include a description of the error, and key fields to assist in identifying the claim that generated the error.

At each step, ISO staff will be available to work during normal business hours with the member on answering questions related to testing and how to make any necessary corrections. They will also keep the member informed if the testing environment is scheduled to be unavailable for any reason during the normal testing window. Due to the heavy volume of customers testing, ISO ClaimSearch will respond to requests within 1 business day, but may take up to 3 business days for investigation and troubleshooting if necessary. In order to test your application completely, we suggest that you first add initial claims to the test database completing as many elements as possible, sending optional elements such as AKAs and Service Providers, sending multiple claims parties and coverage types. After your initial claims have been accepted by the test system, you should then slightly alter some of the key information on those claims (Policy Number, AgencyId, InsurerId, and LossDt - PAIL) to create new initial claims that will produce matches against the original claims. In doing so you will be able to test receiving matching claims. We also suggest that you test updating or replacing previously submitted test claims. In addition, we can provide you with some searchable information that will produce matches in the test system if you code claims using the information provided. The total length of the testing period will vary from company to company depending on the complexity of the programming and the claims being sent and received. ISO ClaimSearch relies on each member to decide when their programming has been fully tested.

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PRODUCTION REQUIREMENTS

Three (3) to four (4) weeks prior to production implementation, ISO ClaimSearch would like to complete the following items. Receive test transmissions of data similar to what would be sent in production from your test database in

order to assess the quality of your data prior to production implementation. Review an example of any customer-designed report as the adjuster will see it prior to production. (Not

required if ISO Stylesheets are being used without changes.) Send XML Connectivity Letter.doc with Production information. Setup production communications and test

a “round-trip” through the chosen communication method with a claim that is coded to reject.. If you plan to send a legacy historical conversion file, it should be sent and processed during this time

period. A meeting should be held with an ISO ClaimSearch representative, the customer’s business area, the

customer’s technical area, and, if a vendor is being used, a representative of the vendor’s company. The purpose of this meeting is for ISO ClaimSearch to gain basic facts about how the customer’s XML Format transmissions were designed, what types of claims are being sent, how errors are being handled, etc. It serves as a check that all steps are in place for the production date. It is also a good time for any other questions by any party on the call.

Please contact your ISO Testing Representative (See Who to Call) to coordinate the details of the above.

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ACORD DEFINITION OF XML TERMS

Definition of Terms

The following terms are used extensively in the ACORD Specification documentation and may have very specific meanings within this context. Aggregate

A number of related elements may be grouped together into an Aggregate. An aggregate provides a mechanism for coding logic rules (“element 1 or element 2 must be provided”), and also provides a convenient way for programmers to specify all of the related information by using a single name. An aggregate is a collection of elements and/or other aggregates. An aggregate may not contain any data itself, but rather contains elements containing data, and/or recursively contains aggregates. Note that multiple aggregates may use the same structure. These are currently documented as Entities in the ACORD Specification. Element

An Element is the most basic unit of data in the ACORD Specification. An element is defined based on one of the supported data types to define a single piece of information passed between the client and server. An element is named according to specific rules and has a definition associated with it to provide additional information on what it contains. An element may also have some usage rules associated with it, which describe how the client and server interact with the element. An ACORD document contains one or more elements. An element includes a data value bound by a leading start tag and a trailing end tag. So, when an element is stated as required, the data value must be included (i.e. Not NULL). For example, an element “TAG,” containing data “SomeData,” would look like this: <TAG>SomeData<\TAG> Note that this definition differs slightly from the World Wide Web Consortium (W3C) XML definition of element in that an ACORD element must contain data, but may not contain other elements. A W3C XML element containing other elements is defined in ACORD as an aggregate. The W3C is the worldwide standards body for web technology. Entity

An Entity acts as a variable for replacement in the ACORD specification. In the specification, we have used entities to describe groups of elements and aggregates that we wish to identify by name and use in one or more locations. In XML, an entity is also used like a variable. An Entity is declared to have a name and then the name is referenced within the DTD or body of the document depending upon the type of entity. An entity can be: Parsed

Character General Parameter

Unparsed Unparsed entities are used for external file attachments typically in a binary format like Tiff or JPEG. Parsed entities act like variables. Character entities allow the numeric value of an entity to be used when it is difficult to create the character from the keyboard. General entities are not used in the ACORD design. Parameter entities are used in the DTD to allow the reuse of common structures or to modularize the DTD. Request

A Request is information sent by the client. An ACORD request file is the entire XML file sent by the client, including the XML header. An individual request generally is an aggregate ending in “Rq.”

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Response

A Response is information sent by the server. An ACORD response file is the entire XML file sent by the server, including the XML header. An individual response generally is an aggregate ending in “Rs.” Data Type Definitions

Boolean

The Boolean datatype has two states, true or false. True is represented by the literal character 1 (one), while False is represented by the literal character 0 (zero). Unless otherwise specified in this document, an option element of type Boolean is implied to be “not answered” if it is absent. Character

Character indicates an element that allows character data up to a maximum number of characters, regardless of the number of bytes required to represent each character. The number after the hyphen specifies the maximum number of characters. For example, C-12, specifies an element of characters with maximum length 12 characters. C-Infinite indicates an element with no maximum length. Long

The Long data type is an integer expressed as a Base-10, ASCII character set string representation of a 32-bit signed integer in the range -2147483648 to =2147483647. Elements of type Long do not permit a decimal point. Phone Number Phone Number indicates a string of up to 32 narrow characters in length (NC-32). It must begin with a plus sign “+” followed by country code, a hyphen, city/area code, another hyphen, and then the local phone number. If a PBX extension is to be included, it must appear at the end of the field, separated from the rest of the telephone number by a plus sign. For example, “+1-800-5551212+739” indicates a phone number in North America (country code 1), area code (800), at phone number (5551212) and PBX extension (739). Identifiers

Assigned Identifiers An Assigned Identifier is created by an organization, carrier, agent, state, or other body. These include policy numbers, social security numbers, passport ID’s, drivers license numbers, etc. Transient Unique Identifiers An ACORD document provides a unique identifier with the XML stream that is used for referencing information within the document. This is a transient identifier that is only used to link information within a document stream. As the word transient implies, the identifiers are not meant for use once the message has been processed by the receiving system. Transient identifiers in the specification are of the data type “Identifier.” This is Character data that matches the XML rules for ID attribute data type values. These identifiers may include alphanumeric characters, but they must start with an alpha or they will be rejected for invalid format.

Tag Type Usage Length Description

@id Identifier Optional A document unique identifier used when an object (element) needs to be referenced elsewhere in the document. An ID should only be present on an element when it is being referenced within the stream.

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Universally Unique Identifier (UUID)

UUID elements are Narrow Characters with a maximum length of 36. Application can often obtain conforming UUIDs by calls to the operating system or the run-time environment. A UUID is an identifier that is unique across both space and time, with respect to the space of all UUIDs. To be precise, the UUID consists of a finite bit space. Thus, the time value used for constructing a UUID is limited and will roll over in the future (approximately at A.D. 3400, based on the specified algorithm). A UUID may be used for multiple purposes, from tagging objects with an extremely short lifetime to reliably identifying very persistent objects across a network. The following information on UUID is based on Internet-Draft <leach-uuids-uuids-01.txt>: The generation of UUIDs does not require that a registration authority be contacted for each identifier. Instead, it requires a unique value over space for each UUID generator. This spatially unique value is specified as an IEEE 802 address, which is usually already available to network-connected systems. This 48-bit address may be assigned based on an address block obtained through the IEEE registration authority. This section of the UUID specification assumes the availability of an IEEE802 address to a system desiring to generate a UUID, but if one is not available, Section 4 specifies a way to generate a probabilistically unique one that cannot conflict with any properly assigned IEEE 802 address 3.1 Format. In its most general form, all that may be said of the UUID format is that a UUID is 16 octets, and that some bits of octet 8 of the UUID called the variant field determine finer structure. For use in human-readable text, a UUID string representation is specified as a sequence of fields, some of which are separate by single dashes. Each field is treated as an integer and has its value printed as a zero filled hexadecimal digit string with the most significant digit first. The hexadecimal values, a-f inclusive, are output as lower case characters, and are not case sensitive on input. The sequence is the same as the UUID constructed type. The following is an example of the string representation of a UUID: f81d4ae-7dec-11d0-a765-00a0c91e6bf6 Date and Time Formats

Date

Elements of data type Date contain an indication of a particular day. This data type describes a unique period of time, normally 24 hours (not a repeating portion of every year). Tags specified as type Date accept dates in the YYYY-MM-DD format. DateTime

Tags specified as type DateTime accept a fully formatted date/time/time zone string. For example, “1996-10-05T13:22:00.124-5:00” represents October 5, 1996, at 1:22 and 124 milliseconds P.M. in Eastern Standard Time. This is the same as 6:22 P.M. Coordinated Universal Time (UTC). Time

Elements of data type Time contain an indication of a particular time during a date. This data type describes a repeating portion of a day. That is, each time described (ignoring leap seconds) occurs once per calendar date. In the specification, it is required that a time data type be able to represent a specific period with indefinite precision. Milliseconds are the minimum required precision of the time data type. Tags specified as type Time accept times in the following format: hh:mm:ss.ffffff±HH:mm Note ISO ClaimSearch has a single Time only field <LossTime>. This field will only accept (hhmm). A time represented using this data type must not be ambiguous with respect to morning and afternoon. That is, the time must occur once and only once each 24-hour period. In addition, the Time data type must not be ambiguous with respect to location at which the time occurs. If unspecified, the time zone defaults to Coordinated Universal Time (UTC). Generally, use of a specific time zone in the representation is preferred. The time zone should always be specified to avoid ambiguous communication between clients and servers.

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SYSTEM INPUT (REQUEST)

Introduction

The ISO ClaimSearch system recognizes two file formats for transmission of claims to the database: the Universal Format (UF) which is the ISO ClaimSearch proprietary flat-text file format; and XML Format (XML) which is based on the ACORD industry-standard file format. Each has their own file layout manual and telecommunication options, however they are considered equivalent in the database as they follow the same processing rules and procedures. Below is a summary of each type of report, the general rules for each type, the structure of each type, and the required fields for each type for the XML Format. Detailed file formats follow directly after. Please contact ISO ClaimSearch at ClaimSearchDatabaseDevelopment@iso.com for a copy of the Universal Format Manual, if you are interested in an alternate format. Types of Reports

An Initial claim is used when a claim is sent to the System for the first time. The claim will be added to the

database and a search will be performed. For additional information on sending initial claims, please refer to the Initial Reports section below.

A Replacement is used to completely over-write the information that was sent in the Initial filing. The

information will be updated in the database and a search will be performed. A Replacement claim may be submitted to execute a new search of the database in order to research a claim. For additional information on replacing records, please refer to the Replacement Reports section below.

An Update will allow specific elements to be updated. Updates are sent using the <com.iso_Update>

aggregate. Updates do not perform searches of the database. For additional information on updating claims, please refer to the Update Reports section below.

A Re-Search will perform a new search on the Initial filing, but will not alter the information that was sent in

the initial report. For additional information on re-searching claims, please refer to the Re-Search Reports section below.

Initial Reports

The first time a claim is sent to ISO ClaimSearch, it should be sent as an Initial claim. Initial claims will be added to the ISO ClaimSearch database and a search to find similar claims will be performed. Only one Initial report needs to be filed listing the claimants and coverages for an accident regardless of the claim type; the system will now accommodate reporting multiple claimants and coverages for a loss. NOTE - It is preferred by ISO ClaimSearch that claims are reported at a claim level rather than an exposure level. ISO ClaimSearch performs a duplicate check upon receipt of an Initial report. The duplicate check will reject claims with the same PolicyNumber, AgencyId, InsurerId, and LossDt . The system will not perform a duplicate check against claims previously submitted in any legacy format. (See Transitioning from Legacy System Reporting for further information.) If a claim is found with the same key fields above, then the initial will be rejected for duplicate.

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Data formats are divided into several Aggregates that describe related portions of a claim submission and the resulting matches. The high level aggregates are summarized below. Claims must be reported and received in a standardized hierarchy structure. This structure is described in detail following the summary of aggregates. XML transmissions may be sent to ISO ClaimSearch with one or more claims per transmission (ClaimsSvcRq level); however ISO ClaimSearch processes XML on a claim by claim basis. ISO ClaimSearch will break up each transmission at the ClaimInvestigationAddRq level, thus processing the claims individually and returning responses individually on a real-time basis.

Summary of XML Request Aggregates in Schema Order

ACORD wrapper Every XML transmission must begin and end with the <ACORD> tag to signify the beginning and end

of transmission. SignonRq

Every XML transmission must contain a <SignonRq> aggregate containing the user ID (Xnnnn) and password for authentication to the ISO system.

ClaimsSvcRq Every XML transmission must contain a single <ClaimsSvcRq> aggregate to indicate the beginning

and ending of the data transmission. ClaimInvestigationAddRq

Every XML transmission must contain at least one <ClaimInvestigationAddRq>. This aggregate indicates the beginning and ending of the claim information.

This aggregate may be repeated to send multiple claims in a single transmission; however ISO ClaimSearch will split the claims at this level and process individually.

The RqUID for the ClaimInvestigationAddRq is returned on the ClaimInvestigationAddRs in order to tie the response back to the request.

The RqUID may not be blank or null. It must contain at least one character or the Response will not be returned to your system.

CodeList This aggregate is required to identify any CodeList used within the transmission that is NOT an

ACORD standard codelist. ACORD standard codelists are identified in Appendix A with (ACORD) after the code list name. CodeList names are case and spelling sensitive.

ReplacementInd This element is used to indicate that the claim exists on the database and should be overwritten with

the claims data listed below. The PolicyNumber, AgencyId, InsurerId, and LossDt will be used to find the existing claim, remove all

data except the key fields, ISO FileNumber, and ISO Received Date, and replace all other claims data provided below.

If the data was on the existing claim, but not on the Replacement then that claims data will be removed from the claim.

If the claims data has been touched on the ClaimSearch Claims Reporting website, then the data may not be removed via system to system, only changed.

com.iso_Update This aggregate is only submitted when using the Update process to report updates to a section of the

claim. Please see the section on Replacements and Updates for further information. SuppressMatchInd

This element is used to indicate that the entire claim should be added to the database but not searched.

If this indicator is set to 1:

This will return a Reject Response if there is a data error.

This will NOT return a Success Response.

This will NOT return CMS Warnings. SearchBasisCd

This element is used only in conjunction with UpdateInd=4 to indicate if the research is done on an individual party (I) or the entire claim (C).

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Policy This aggregate is required to report the policy information for the claim being reported as well as the

AgencyId (ISO Member Code). If you are a self-insured that does not use a policy number, the claim number (InsurerId) may be

repeated in the policy number (PolicyNumber) field. This aggregate also contains Physical Risk Address, Mailing Address, SIU Contact information, and

NMVTIS reporting code. ClaimsOccurrence

This aggregate is required to report common elements common of the claim (ex. Incident Description) ItemIdInfo/InsurerId (Claim Number), LossDt (Loss Date), and Addr/StateProvCd (Location of Loss

State) are required on every initial, replacement, and update Request. This aggregate also contains RRE Code, TIN, and Site ID for CMS reporting.

ClaimsParty At least one is required, only the first 99 involved parties reported will be searched. This aggregate is used to report persons or organizations involved in the claim. This can include

involved parties, service providers, aliases, salvage buyers, CMS additional claimants, etc. Specific roles are identified through the use of the ClaimsPartyRole (ACORD) or ClaimsPartyRoleCd

code lists in Appendix A and Appendix D. GeneralPartyInfo

NameInfo

This aggregate can be used to report either a Business Name <CommlName> unparsed up to 70 characters OR an Individual Name <PersonName> parsed into first, middle, and surnames.

NameInfo is required on all involved parties, service providers, recovering agencies, and salvage buyers.

NameInfo is not required on an Alias as long as an Addr is provided, however if it is provided it will be searched to enhance the search results.

CMS reporting may have additional requirements specific to CMS role codes.

Addr

This aggregate is used to report the address associated with the NameInfo provided directly above it.

AddrTypeCd element is NOT used outside of the Policy aggregate.

Addr1, City, and StateProvCd are required on all involved parties

City and StateProvCd are required for all service providers

Addr aggregate is not required for recovering agencies or salvage buyers

Addr aggregate is not required for Alias as long as a NameInfo is provided.

CMS reporting may have additional requirements specific to CMS role codes.

Although the following data elements are not always required, if provided they can be searched (depending on role code) and enhance your search results – Addr1, City, StateProvCd, and PostalCode.

Communications

This aggregate can be used to report the following phone types and email address: Home Telephone – PhoneTypeCd = Phone; CommunicationUseCd = Home Business Telephone – PhoneTypeCd = Phone; CommunicationUseCd = Business Cellular Telephone – PhoneTypeCd = Cell; CommunicationUseCd = ** Pager – PhoneTypeCd = Pager; CommunicationUseCd = ** Fax Number – PhoneTypeCd = Fax; CommunicationUseCd = ** (Fax is Request Only) EmailAddr – In this location, Alias email address only. See com.iso_SIUParty for Involved

Party or Service Provider email address. ** can enter either Home or Business, this is ignored and only one cell, pager, or fax per ClaimsParty is stored in system with no indication of personal/business use.

PersonInfo

This aggregate is used to report Gender, Birth Date, and Occupation of the ClaimsParty. It is entirely optional for ClaimSearch Basic Service Reporting.

The reporting of Birth Date is required for CMS reporting. Reporting Gender is optional for CMS

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Reporting, but is useful in determining matches. ClaimsPartyInfo

This aggregate is used to report the ClaimsPartyRoleCd to identify the ClaimsParty’s role in the claim. Please see Appendices A and D for further information.

This aggregate can also be used to report whether the party has filed a Law Suit (SuitFiledInd) or the Closed Date (ClosedDt) of a particular coverage. Both of these elements require an idref referring to the particular coverage (ClaimsInjuredInfo, AutoLossInfo, or PropertyLossInfo) that it is being reported for, and may be repeated to provide individual data on multiple coverages.

ClaimsDriverInfo

This aggregate is entirely optional and allows for the reporting of the Driver’s License Number and State of the ClaimsParty as well as the Operator at Fault Indicator.

Although the information is optional, driver’s license and state are searchable elements and will enhance the search results if submitted on a searchable ClaimsParty.

ClaimsInjuredInfo

This aggregate is required for all involved parties with injuries, liabilities (such as harassment or slander), or 3

rd party property damage. It may be repeated as necessary to cover all coverage/loss

types being claimed.

This aggregate must have its own ID for reference.

Not allowed if the ClaimsPartyRole is Owner, Partner, Tenant, Witness, Alias, or any of the Service Provider role codes listed in Appendix D.

PartyInvestigationInfo

This aggregate is optional and only used to report the SuppressMatchInd on the ClaimsParty level. This indicates that the submitter only wants the data to be added to the database. No search will be completed, Reject Response will be returned, Success Response will NOT be returned, and CMS Warning Codes will still be generated for this party.

com.iso_ClaimsPartyVehInfo

This aggregate is optional and only used to report the VIN of the vehicle the party was an occupant of and whether there was physical damage to the vehicle.

com.iso_CSLNInd

This indicator is used by TPA’s for Child Support Enforcement Agency Reporting. Please see the Optional Services section for further information.

ClaimsPartyRelationship Service Provider or AKA information (Alias) must be listed in its own ClaimsParty aggregate. The ClaimsPartyRelationship aggregate is required to tie the involved party’s ClaimsParty

(ClaimsParty1Ref) to the Service Provider or AKA ClaimsParty (ClaimsParty2Ref). Multiple Service Providers may be tied to a single involved party ClaimsParty. Multiple AKA Information may be tied to either an involved party ClaimsParty or a service provider

ClaimsParty. com.iso_SIUParty

This aggregate contains data elements for Special Investigation details and CMS required fields, including com.iso_MedicareEligibleInd and HICN.

This aggregate can reference either an involved party (i.e. claimant or insured role codes) for Special Investigation details, CMS required fields, or email address.

This aggregate can reference a service provider, only for Special Investigation details or email address. This aggregate REQUIRES an idref to an involved party’s or a service provider’s <ClaimsParty>

aggregate. Without the idref, the data will be dropped from the claim and NO data, including CMS required fields, will be retained.

AdjusterParty The Adjuster name and contact information within this aggregate is optional, but the AdjusterPartyInfo

is required. Only one Adjuster name and contact information may be reported per individual ClaimsInjuredInfo,

AutoLossInfo, or PropertyLossInfo aggregates.

The aggregate may be repeated if more than one Adjuster is handling separate ClaimsInjuredInfo,

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AutoLossInfo, or PropertyLossInfo aggregates. (For example, there is one adjuster handling the ClaimsInjuredInfo and one adjuster handling the AutoLossInfo on the same claim, this aggregate may be repeated and refer to the individual coverages that each adjuster is handling.)

AdjusterPartyInfo

This aggregate is required and associates the coverage and loss types as reported in this aggregate to the appropriate loss section of the claim (ClaimsInjuredInfo, AutoLossInfo, or PropertyLossInfo).

This aggregate may be repeated within a single AdjusterParty aggregate – once for each coverage and loss type reported on a claim.

Each loss section (ClaimsInjuredInfo, AutoLossInfo, or PropertyLossInfo) must be referred to by at least one AdjusterPartyInfo.

AutoLossInfo This aggregate must have its own ID for reference. This aggregate is required for the reporting of damage to a 1

st party vehicle, should reference the

ClaimsParty making the claim, and requires VIN, Year, and Make for 1st Party losses.

This aggregate may be used to report damage to a 3rd party vehicle; however VIN, Year and Make are

not required on 3rd party vehicles. Only the AutoLossInfo Id and ClaimsPartyRef are required so that

the coverage and loss types being applied may be connected to the appropriate ClaimsParty. Not allowed if the role is Claimant Pedestrian, Insured Employee, Partner, Tenant, Witness, Alias, or

any of the Service Provider role codes listed in Appendix D. This aggregate may be repeated up to 100 times per involved party to report multiple vehicles involved

in a claim. This aggregate SHOULD NOT BE SENT if the vehicle has not sustained damage or is not being

reported stolen. PropertyLossInfo

This aggregate must have its own ID for reference. Multiple PropertyLossInfo aggregates may be reported on a claim; however the PropertyLossInfo must

contain only one <Watercraft> aggregate, OR one <ItemInfo>, OR one or more <ClaimsSubjectInsuranceInfo> aggregates.

PropertyLossInfo aggregate should be associated with the first ClaimsParty on a claim with multiple claim types or it may not display correctly on ISO ClaimSearch web reports.

Only allowed if the role is Insured, Claimant/Insured, Tenant, Partner, Insured Passenger, or Insured Driver.

PropertySchedule

If a theft is being reported, then the PropertySchedule aggregate should be used in conjunction with the ClaimsSubjectInsuranceInfo to report the types of items stolen. At least one type is required. May be repeated to report multiple items.

If a theft is being reported, then PropertySchedule/ ItemDefinition/ ItemTypeCd uses “SubjectInsuranceCd” codelist with the value indicating a type of stolen item.

If the loss type is other than theft and scheduled property is being reported, this may be done using the PropertySchedule/ ItemDefinition/ ItemTypeCd.

Only one of the following sub-aggregates may be reported on a PropertyLossInfo:

ItemInfo

This aggregate is required for the reporting of an off-road or mobile equipment claim.

ItemDefinition/ ItemTypeCd uses “ItemDefinition” codelist with a value of “MoblEquip”

Watercraft

This aggregate is required for the reporting of a claim on a boat policy (hull or motor coverage).

ItemInfo/ ItemDefinition/ ItemTypeCd uses “ItemDefinition” codelist with a value of “Watercraft”

ClaimsSubjectInsuranceInfo

This aggregate is required for the reporting of 1st party property losses (fire, theft, other peril).

This aggregate may be repeated within the <PropertyLossInfo> aggregate.

1st Party property insurance does not use coverages and only a single loss type may be

reported on the claim.

ClaimsPayment

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This aggregate lists the section of the policy applied (Building, Contents, Stock, Loss of Use, or Other) and the dollar amounts for Policy Amount, Reserve, Estimated Loss, or Payment Amount. This is considered the coverage on a property claim. Although these are listed as optional, it is recommended to have at least one completed to show what the claim is for.

Note – Estimated Loss is required by some State Fire Marshalls for the reporting of fire losses to their specific states.

WorkCompLossInfo This aggregate is optional and used to report elements specific to Workers’ Compensation claims and

Marine Casualty Claims (Commercial Ocean Marine and Longshore/Harborworkers’ Workers’ Compensation.)

LitigationInfo This aggregate only refers to injury, liability or 3

rd party property damage claims where an involved party

has filed a lawsuit. If the <PlaintiffRef> refers to an AutoLossInfo or PropertyLossInfo, the information provided will be dropped out in the processing of the claim and not stored on the ClaimSearch system.

ClaimsPayment This aggregate is optional and is used to identify the dollar amounts for Policy Amount, Reserve,

Estimated Loss, or Payment Amount as well as the Claim Status (ex. open, closed, closed without payment, etc).

This aggregate is used in for reporting the dollar amounts associated with ClaimsInjuredInfo, AutoLossInfo, PropertyLossInfo/ItemInfo, and PropertyLossInfo/Watercraft. Please see Appendix E – Claims Payment and Status Reporting Rules for further information.

RemarkText This element is used to assist with the distribution of reports within your company. The data provided in

this element is stored and echoed back as part of the claim information to the submitting company only (i.e. not provided as part of the match details to other companies).

This element can refer to ClaimsOccurrence for claim level information, ClaimsParty for claims party level information, or ClaimsInjuredInfo, AutoLossInfo, or PropertyLossInfo for coverage level information.

The field length is 20 characters long, EXCEPT when referring to a ClaimsParty then it is limited to 5 characters in length.

InvestigationInfo This aggregate is used to report Theft Recovery or Salvage information for vehicles or boats. This aggregate also contains the Vehicle Disposition Code required for NMVTIS reporting. RecoveryInfo

This aggregate provides information regarding the recovery of stolen vehicles or boats.

This aggregate may include data supplied by the insuring company on a request, or on a response it may contain data as provided by insurance company, police agencies, or National Insurance Crime Bureau (NICB.)

SalvageInfo

This aggregate provide information regarding the salvage of a vehicle, boat, or mobile equipment.

If salvage is being purchased by a 3rd party, then a reference to a ClaimsParty with the role code of

SalvageBuyer is required.

VIN is an optional field for most physical damage claims with a 3rd party (CL, CD, or CP) claimant

role code. If a salvage is being reported for the claim, VIN becomes a required field.

Please see Optional Services for additional requirements specific to NMVTIS reporting. com.iso_AddInfo

This aggregate contains Additional Coverage Information including the Coverage Information 1, Coverage Information 2.

com.iso_CovInfo1

This aggregate captures fields required by CMS for Medicare Eligible Individuals.

This aggregate refers to the ClaimsInjuredInfo aggregate to which it is associated.

It may refer to an AutoLossInfo aggregate only if company is reporting casualty information using an AutoLossInfo aggregate.

com.iso_CovInfo2

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This aggregate captures fields optional for CMS reporting and Mass Tort reporting

This aggregate refers to the ClaimsInjuredInfo aggregate to which it is associated.

It may refer to an AutoLossInfo aggregate only if company is reporting casualty information using an AutoLossInfo aggregate.

com.iso_ClaimDirectorInd Please see Optional Services – ClaimDirector for further information on this element.

com.iso_ConvertLegacyToUFInd This element is used to indicate that the claim was previously reported in INDEX or PILR format. The

system will search to find the previous claim by the key fields of the former format, remove it from the system, and add the XML format claim. If no claim is found or if no clear match exists, the system will simply add the XML Format claim.

com.iso_RecallRqInd This element is used to request Vehicle Recall information from National Highway Transportation

Safety Administration (NHTSA). Please see Additional Services for further information.

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ISO ClaimSearch XML Structure

ISO ClaimSearch XML transmissions require a specific basic XML structure as well as certain required aggregates and elements for the reporting of Initial Reports. Below is an explanation of the basic structure and required elements common to all claims, followed by an explanation of how to report claims by line of business and type of claim. Each of the line of business sections include a description of the type of claim reported, the high level XML structure and the required elements specific to the type of claim being reported. See Special Programming Notes for a listing of the Searchable Elements that are not required on any claim, but if provided will be searched to improve your search results. The basic hierarchy structure of an XML transmission is defined by the order that Entities, Wrappers, Aggregates, and Elements are listed within the tables in the file layout section of the manual. Please follow this order when programming the XML Structure. ISO ClaimSearch also provides a Schema file to assist in the programming of Request hierarchy. NOTE – The Schema file is not used to verify the hierarchy of Response transmissions. The following section describes the MINIMUM aggregates required for a successful submission to ISO ClaimSearch. Other aggregates and elements may be used to report optional information. Also, there may be additional elements required by the ACORD specification, not listed in this section. In addition, due to the nature of ACORD XML, there are certain identifiers and references that ISO requires to properly interpret the XML. These have been marked as “Required” in their proper context in a later section of this manual. Common Aggregates

In order to report any claim, you will always need to report the following aggregates: ACORD – to identify the beginning and end of transmission SignonRq – for authentication ClaimsSvcRq/ClaimInvestigationAddRq – for XML transaction information CodeList aggregates – to list all non-ACORD code lists used within the file Policy aggregate – to identify information regarding the policy itself ClaimsOccurrence – to identify the information that applies to the entire claim ClaimsParty aggregate – to identify the individuals or organizations involved in the claim. It is also not necessary to report an individual who has not been injured and who does not have a vehicle or property damaged in the accident. AdjusterPartyInfo aggregate – to identify the coverage and loss type(s) that apply to the individuals or organizations making claims against the policy Further information is given below in each section. Other aggregates are required based on line of business as outlined in the following sections.

Required Elements – Initial Reports

The following section describes the MINIMUM elements required for a successful submission to ISO ClaimSearch. Other Elements may be used to report optional information. Also, there are additional elements required by the ACORD specification, not listed in this section. In addition, due to the nature of ACORD XML, there are certain identifiers and references that ISO requires to properly interpret the XML. These have been marked as “Required” in their proper context in a later section of this manual.

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Common Elements

The following elements are required for each claim submitted. Other elements are required based on line of business as outlined in the following sections.

Data Element Location

Policy Number ClaimInvestigationAddRq/ Policy/ PolicyNumber

Policy Type ClaimInvestigationAddRq/ Policy/ LOBCd

Insuring Company ID ClaimInvestigationAddRq/ Policy/ MiscParty/ ItemIdInfo/ AgencyId and ClaimInvestigationAddRq/Policy/MiscParty/MiscPartyRoleCd = “CarrierInsurer”

Claim Number ClaimInvestigationAddRq/ ClaimsOccurrence/ ItemIdInfo/ InsurerId

Date of Loss ClaimInvestigationAddRq/ ClaimsOccurrence/ LossDt

Incident Description ClaimInvestigationAddRq/ ClaimsOccurrence/ IncidentDesc

Location of Loss State ClaimInvestigationAddRq/ ClaimsOccurrence/ Addr/ StateProvCd

Coverage Type ClaimInvestigationAddRq/ AdjusterParty/ AdjusterPartyInfo/ CoverageCd (except for 1st party

property losses, please see property claims section for further information)

Loss Type ClaimInvestigationAddRq/ AdjusterParty/ AdjusterPartyInfo/ LossCauseCd

Party Elements

The following elements are required for ClaimsParty aggregates. Service Providers are not required to have address information (name, city, and role code only). AKA information may be submitted with any of the fields of information (role code of Alias is required), but will only be searched if the ClaimsParty or Service Provider that it is related to is a searchable role code. NOTE: You must include a ClaimsParty for the Insured and a ClaimsParty for each of the Claimants on the loss. If the party is both a Claimant and Insured, then a single ClaimsParty may be reported with a role code of CI.

Data Element Location

Business Name (if a business) ClaimInvestigationAddRq/ ClaimsParty/ GeneralPartyInfo/ NameInfo/ CommlName/ CommercialName

First Name (if an individual) ClaimInvestigationAddRq/ ClaimsParty/ GeneralPartyInfo/ NameInfo/ PersonName/ GivenName

Last Name (if an individual) ClaimInvestigationAddRq/ ClaimsParty/ GeneralPartyInfo/ NameInfo/ PersonName/ Surname

Address Information Line 1 ClaimInvestigationAddRq/ ClaimsParty/ GeneralPartyInfo/ Addr/ Addr1

City ClaimInvestigationAddRq/ ClaimsParty/ GeneralPartyInfo/ Addr/ City

State ClaimInvestigationAddRq/ ClaimsParty/ GeneralPartyInfo/ Addr/ StateProvCd

Role in the Claim ClaimInvestigationAddRq/ ClaimsParty/ ClaimsPartyInfo/ ClaimsPartyRoleCd

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Casualty Claims

The majority of casualty claims involve at least two claims parties – the insured that is named on the policy; and the claimant that was physically injured, liabled (harassment, slander, wrongful termination, etc), or had property damaged due to the insured. There are a few coverages that may apply directly to the insured (PIP, uninsured motorist, or underinsured motorists). For these coverages, a single claims party may be submitted with a role code of CI for Claimant and Insured. These aggregates are used regardless of the type of policy (Commercial Liability, Commercial Auto, Personal Liability [including Homeowners Liability], Personal Auto, Workers Compensation, Accident & Health, or Life). If the injury or liability claim is being applied against an auto policy, it is NOT necessary to report the vehicle involved UNLESS the vehicle itself has been damaged. What follows are the minimum aggregates and elements required to report the casualty part of the claim. This can be reported by itself or in combination with the vehicle and property claims below. 1. Claims Party Aggregate 1 = the name, street address, city, state, and role code indicating the party as the

Insured; required to have its own Id for future reference 2. Claims Party Aggregate 2 = the name, street address, city, state, and role code indicating the party as the

Claimant; required to have its own Id for future reference 3. ClaimsInjuredInfo Aggregate = lists the exact injury or property damage description; required to have its

own Id for future reference. This is a subaggregate of the Claimant’s ClaimsParty Aggregate 4. AdjusterPartyInfo Aggregate = lists the coverage and loss types being applied to the loss; refers back to

ClaimsInjuredInfo Aggregate. <ACORD> <SignonRq>…</SignonRq> <ClaimsSvcRq>

<ClaimInvestigationAddRq>

<RqUID>…</RqUID>

<TransactionRequestDt>…</TransactionRequestDt>

<CurCd>…</CurCd>

<CodeList>……. </CodeList>

<Policy>……</Policy>

<ClaimsOccurrence>…. </ClaimsOccurrence>

<ClaimsParty>

<GeneralPartyInfo>.... </GeneralPartyInfo>

<ClaimsPartyInfo>.... </ClaimsPartyInfo>

</ClaimsParty>

<ClaimsParty>

<GeneralPartyInfo>.... </GeneralPartyInfo>

<ClaimsPartyInfo>.... </ClaimsPartyInfo>

<ClaimsInjuredInfo> ...... </ClaimsInjuredInfo>

</ClaimsParty>

<AdjusterParty>

<AdjusterPartyInfo>…</AdjusterPartyInfo>

</AdjusterParty>

</ClaimInvestigationAddRq>

</ClaimsSvcRq>

</ACORD>

The following elements are required for damage to persons or third-party property.

Data Element Location

@id ClaimInvestigationAddRq/ ClaimsParty/ ClaimsInjuredInfo id=” “

Alleged Injuries/ Property Damage ClaimInvestigationAddRq/ ClaimsParty/ ClaimsInjuredInfo/ ClaimsInjury/ InjuryNatureDesc

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Vehicle Claims

Vehicle claims may be applied to 1

st party losses (insured placing a claim against his/her own policy) or 3

rd party

losses (claimant placing a claim against someone else’s policy). These aggregates are used regardless of the type of policy (Commercial Auto or Personal Auto). DO NOT SEND this aggregate UNLESS a coverage and loss type is being applied to this vehicle. What follows are the minimum aggregates and elements required to report the vehicle part of the claim. This can be reported by itself or in combination with the casualty claims above and property claims below. Auto Claim – 1

st Party

In the case of a 1

st party loss, a single claims party may be submitted with the role code of CI for Claimant and

Insured.

1. Claims Party Aggregate 1 = the name, street address, city, state, and role code indicating the party as the Claimant and Insured; required to have its own Id for future reference.

2. AdjusterPartyInfo Aggregate = lists the coverage and loss types being applied to the loss; refers back to AutoLossInfo Aggregate.

3. AutoLossInfo Aggregate = lists the VIN, make, and year of the vehicle that was damaged; required to have its own Id for future reference; refers back to the Claimant and Insured’s ClaimsParty Id.

<ACORD> <SignonRq>…</SignonRq> <ClaimsSvcRq>

<ClaimInvestigationAddRq>

<RqUID>…</RqUID>

<TransactionRequestDt>…</TransactionRequestDt>

<CurCd>…</CurCd>

<CodeList>……. </CodeList>

<Policy>……</Policy>

<ClaimsOccurrence>…. </ClaimsOccurrence>

<ClaimsParty>

<GeneralPartyInfo>.... </GeneralPartyInfo>

<ClaimsPartyInfo>.... </ClaimsPartyInfo>

</ClaimsParty>

<AdjusterParty>

<AdjusterPartyInfo>…</AdjusterPartyInfo>

</AdjusterParty>

<AutoLossInfo>…. </AutoLossInfo>

</ClaimInvestigationAddRq>

</ClaimsSvcRq>

</ACORD>

The following elements are required per 1

st party vehicle loss.

Data Element Location

@id ClaimInvestigationAddRq/ AutoLossInfo id=” “ ClaimsPartyRef=” “

@ClaimsPartyRef

Vehicle Year ClaimInvestigationAddRq/ AutoLossInfo/ VehInfo/ ModelYear

Make ClaimInvestigationAddRq/ AutoLossInfo/ ManufacturerCd

VIN ClaimInvestigationAddRq/ AutoLossInfo/ VehInfo/ VehIdentificationNumber

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Auto Claim – 3rd

Party

In the case of a 3rd party loss, at least two claims parties must be sent – the insured that is named on the policy; and the claimant whose vehicle was physically damaged by the insured.

1. Claims Party Aggregate 1 = the name, street address, city, state, and role code indicating the party as the Insured; required to have its own Id for future reference

2. Claims Party Aggregate 2 = the name, street address, city, state, and role code indicating the party as the Claimant; required to have its own Id for future reference

3. AdjusterPartyInfo Aggregate = lists the coverage and loss types being applied to the loss; refers back to AutoLossInfo Aggregate.

4. AutoLossInfo Aggregate = lists the VIN, make, and year of the vehicle that was damaged; required to have its own Id for future reference; refers back to the Claimant’s ClaimsParty Id. VIN, make, and year are NOT required for 3

rd party claimants, but you must still have an AutoLossInfo aggregate with @id

and ClaimsPartyRef to correctly apply the coverage to the ClaimsParty making the claim. <ACORD> <SignonRq>…</SignonRq> <ClaimsSvcRq>

<ClaimInvestigationAddRq>

<RqUID>…</RqUID>

<TransactionRequestDt>…</TransactionRequestDt>

<CurCd>…</CurCd>

<CodeList>……. </CodeList>

<Policy>……</Policy>

<ClaimsOccurrence>…. </ClaimsOccurrence>

<ClaimsParty>

<GeneralPartyInfo>.... </GeneralPartyInfo>

<ClaimsPartyInfo>.... </ClaimsPartyInfo>

</ClaimsParty>

<ClaimsParty>

<GeneralPartyInfo>.... </GeneralPartyInfo>

<ClaimsPartyInfo>.... </ClaimsPartyInfo>

</ClaimsParty>

<AdjusterParty>

<AdjusterPartyInfo>…</AdjusterPartyInfo>

</AdjusterParty>

<AutoLossInfo>…. </AutoLossInfo>

</ClaimInvestigationAddRq>

</ClaimsSvcRq>

</ACORD>

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Auto Claim – 1st and 3

rd Party

In the case where both 1

st party and 3

rd party damage are being reported, the following would be the

minimum: 1. Claims Party Aggregate 1 = the name, street address, city, state, and role code indicating the party as

the Claimant and Insured; required to have its own Id for future reference 2. Claims Party Aggregate 2 = the name, street address, city, state, and role code indicating the party as

the Claimant; required to have its own Id for future reference 3. AdjusterPartyInfo Aggregate = lists the coverage and loss types being applied to the loss; refers back

to AutoLossInfo Aggregate of the Claimant and Insured’s vehicle. 4. AdjusterPartyInfo Aggregate = lists the coverage and loss types being applied to the loss; refers back

to AutoLossInfo Aggregate of the Claimant’s vehicle. 5. AutoLossInfo Aggregate = lists the VIN, make, and year of the vehicle that was damaged; required to

have its own Id for future reference; refers back to the Claimant and Insured’s ClaimsParty Id. 5. AutoLossInfo Aggregate = lists the VIN, make, and year of the vehicle that was damaged; required to

have its own Id for future reference; refers back to the Claimant’s ClaimsParty Id. VIN, make, and year are NOT required for 3

rd party claimants, but you must still have an AutoLossInfo aggregate with @id

and ClaimsPartyRef to correctly apply the coverage to the ClaimsParty making the claim. <ACORD> <SignonRq>…</SignonRq> <ClaimsSvcRq>

<ClaimInvestigationAddRq>

<RqUID>…</RqUID>

<TransactionRequestDt>…</TransactionRequestDt>

<CurCd>…</CurCd>

<CodeList>……. </CodeList>

<Policy>……</Policy>

<ClaimsOccurrence>…. </ClaimsOccurrence>

<ClaimsParty>

<GeneralPartyInfo>.... </GeneralPartyInfo>

<ClaimsPartyInfo>.... </ClaimsPartyInfo>

</ClaimsParty>

<ClaimsParty>

<GeneralPartyInfo>.... </GeneralPartyInfo>

<ClaimsPartyInfo>.... </ClaimsPartyInfo>

</ClaimsParty>

<AdjusterParty>

<AdjusterPartyInfo>…</AdjusterPartyInfo>

<AdjusterPartyInfo>…</AdjusterPartyInfo>

</AdjusterParty>

<AutoLossInfo>…. </AutoLossInfo>

<AutoLossInfo>…. </AutoLossInfo>

</ClaimInvestigationAddRq>

</ClaimsSvcRq>

</ACORD>

31

Auto Claim – Multiple Vehicles for Single ClaimsParty

In the case where both a single ClaimsParty is reporting damage to multiple vehicles, the following would be the minimum. Multiple vehicles for multiple claims parties are also allowed.

1. Claims Party Aggregate 1 = the name, street address, city, state, and role code indicating the party as

the Claimant and Insured; required to have its own Id for future reference 2. AdjusterPartyInfo Aggregate = lists the coverage and loss types being applied to the loss; refers back

to AutoLossInfo Aggregate of the Claimant and Insured’s vehicle 1. 3. AdjusterPartyInfo Aggregate = lists the coverage and loss types being applied to the loss; refers back

to AutoLossInfo Aggregate of the Claimant and Insured’s vehicle 2. 4. AutoLossInfo Aggregate = lists the VIN, make, and year of the first vehicle that was damaged; required

to have its own Id for future reference; refers back to the Claimant and Insured’s ClaimsParty Id. 5. AutoLossInfo Aggregate = lists the VIN, make, and year of the second vehicle that was damaged;

required to have its own Id for future reference; refers back to the Claimant and Insured’s ClaimsParty Id.

NOTE – Multiple vehicles may be reported for a single ClaimsParty with the same coverage and loss types, however they must have unique VIN numbers or the claim will reject. Up to 100 VINs may be reported for a single ClaimsParty. <ACORD> <SignonRq>…</SignonRq> <ClaimsSvcRq>

<ClaimInvestigationAddRq>

<RqUID>…</RqUID>

<TransactionRequestDt>…</TransactionRequestDt>

<CurCd>…</CurCd>

<CodeList>……. </CodeList>

<Policy>……</Policy>

<ClaimsOccurrence>…. </ClaimsOccurrence>

<ClaimsParty>

<GeneralPartyInfo>.... </GeneralPartyInfo>

<ClaimsPartyInfo>.... </ClaimsPartyInfo>

</ClaimsParty>

<AdjusterParty>

<AdjusterPartyInfo>…</AdjusterPartyInfo>

<AdjusterPartyInfo>…</AdjusterPartyInfo>

</AdjusterParty>

<AutoLossInfo>…. </AutoLossInfo>

<AutoLossInfo>…. </AutoLossInfo>

</ClaimInvestigationAddRq>

</ClaimsSvcRq>

</ACORD>

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Property Claims

The majority of property claims involve only one claims party – the insured that is named on the policy. For these claims, a single claims party may be submitted with a role code of CI for Claimant and Insured or simply IN for insured. These aggregates are used regardless of the type of policy (Commercial Property or Personal Property). What follows are the minimum aggregates and elements required to report the property part of the claim. This can be reported by itself or in combination with the casualty and vehicle claims above. Note: PropertyLossInfo aggregate should be associated with the first ClaimsParty on a claim with multiple claim

types or it may not display correctly on ISO ClaimSearch web reports. Property Damage to 3

rd party property is reported as a LIABILITY claim describing the damages in the

InjuryNatureDesc of the ClaimsInjuredInfo. (For example, a car drives into a building. The damage to the building is reported on the ClaimsInjuredInfo and no PropertyLossInfo aggregate is used for this claim.)

A 1st party general property claim <ClaimsSubjectInsuranceInfo> may be reported in conjunction with a

single boat policy claim <Watercraft>, OR <ClaimsSubjectInsuranceInfo> in conjunction with a single off-road/mobile equipment claim <ItemInfo>; however, <Watercraft> and <ItemInfo>, multiple <Watercraft>, or multiple <ItemInfo> are still not allowed to be reported within a single claim.

1

st Party Property Claim (Fire, Other Peril)

In the case of the loss types of Fire or Other Perils, the following would be the minimum: 1. Claims Party Aggregate 1 = the name, street address, city, state, and role code indicating the party as

the Claimant and Insured; required to have its own Id for future reference 2. AdjusterPartyInfo Aggregate = lists the loss type only being applied to the loss (there is no coverage in

property claims); refers back to PropertyLossInfo Aggregate. 3. PropertyLossInfo Aggregate = required to have its own Id for future reference; refers back to the

Claimant and Insured’s ClaimsParty Id. a. ClaimsSubjectInsuranceInfo = lists the section of the policy applied (Building, Contents, Stock,

Loss of Use, or Other) and the dollar amounts for Policy Amount, Reserve, Estimated Loss, or Payment Amount. This is considered the coverage on a Property claim. Although these are listed as optional, it is suggested to have at least one completed to show what the claim is for.

<ACORD> <SignonRq>…</SignonRq> <ClaimsSvcRq>

<ClaimInvestigationAddRq>

<RqUID>…. </RqUID>

<TransactionRequestDt>…</TransactionRequestDt>

<CurCd>…</CurCd>

<CodeList>……. </CodeList>

<Policy>……</Policy>

<ClaimsOccurrence>…. </ClaimsOccurrence>

<ClaimsParty>

<GeneralPartyInfo>.... </GeneralPartyInfo>

<ClaimsPartyInfo>.... </ClaimsPartyInfo>

</ClaimsParty>

<AdjusterParty>

<AdjusterPartyInfo>…</AdjusterPartyInfo>

</AdjusterParty>

<PropertyLossInfo>

<ClaimsSubjectInsuranceInfo>…</ClaimsSubjectInsuranceInfo>

</PropertyLossInfo>

</ClaimInvestigationAddRq>

</ClaimsSvcRq>

</ACORD>

The following elements are requested, but not required per first-party property loss.

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Data Element Location

@id ClaimInvestigationAddRq/ PropertyLossInfo id=” “

Policy Section (identifies coverage)

ClaimInvestigationAddRq/ PropertyLossInfo/ ClaimsSubjectInsuranceInfo/ SubjectInsuranceCd

Dollar Amount in one of these fields

ClaimInvestigationAddRq/ PropertyLossInfo/ ClaimsSubjectInsuranceInfo/ InsuranceAmt (Policy Amt)

OR ProbableIncurredAmt (Estimated Loss Amount)

OR ClaimsPayment/ClaimsPaymentCovInfo/PaymentAmt (Loss Reserve or Settlement Amount)

1

st Party Property Claim (Theft)

In the case of the loss types of Theft, the following would be the minimum: 1. Claims Party Aggregate 1 = the name, street address, city, state, and role code indicating the party as

the Claimant and Insured; required to have its own Id for future reference 2. AdjusterPartyInfo Aggregate = lists the loss type only being applied to the loss (there is no coverage in

property claims); refers back to PropertyLossInfo Aggregate. 3. PropertyLossInfo Aggregate = required to have its own Id for future reference; refers back to the

Claimant and Insured’s ClaimsParty Id. a. PropertyScheduleInfo = lists the item(s) stolen. b. ClaimsSubjectInsuranceInfo = lists the section(s) of the policy applied (Building, Contents,

Stock, Loss of Use, or Other) and the dollar amounts for Policy Amount, Reserve, Estimated Loss, or Payment Amount. This is considered the coverage on a Property claim. Although these are listed as optional, it is recommended to have at least one completed to show what the claim is for.

<ACORD> <SignonRq>…</SignonRq> <ClaimsSvcRq>

<ClaimInvestigationAddRq>

<RqUID>….</RqUID>

<TransactionRequestDt>…</TransactionRequestDt>

<CurCd>…</CurCd>

<CodeList>……. </CodeList>

<Policy>……</Policy>

<ClaimsOccurrence>…. </ClaimsOccurrence>

<ClaimsParty>

<GeneralPartyInfo>.... </GeneralPartyInfo>

<ClaimsPartyInfo>.... </ClaimsPartyInfo>

</ClaimsParty>

<AdjusterParty>

<AdjusterPartyInfo>…</AdjusterPartyInfo>

</AdjusterParty>

<PropertyLossInfo>

<PropertySchedule>…</PropertySchedule>

<ClaimsSubjectInsuranceInfo>…</ClaimsSubjectInsuranceInfo>

</PropertyLossInfo>

</ClaimInvestigationAddRq>

</ClaimsSvcRq>

</ACORD>

The following elements are required per first-party property loss.

Data Element Location

Theft Items (for thefts only) ClaimInvestigationAddRq/ PropertyLossInfo/ PropertySchedule/ ItemDefinition/ ItemTypeCd (SubjectInsuranceCd code list)

34

Boat

In the case of a claim for physical damages to a boat on a Boat policy, the following would be the minimum:

1. Claims Party Aggregate 1 = the name, street address, city, state, and role code indicating the party as the Claimant and Insured; required to have its own Id for future reference

2. AdjusterPartyInfo Aggregate = lists the loss type only being applied to the coverage and loss; refers back to PropertyLossInfo Aggregate.

3. PropertyLossInfo Aggregate = required to have its own Id for future reference; refers back to the Claimant and Insured’s ClaimsParty Id.

a. Watercraft = lists the HIN, Make, and Year of the boat that the coverage and loss type are being applied to.

b. Note - A 1

st party general property claim <ClaimsSubjectInsuranceInfo> may be reported in conjunction with a

single boat policy claim <Watercraft>, OR <ClaimsSubjectInsuranceInfo> in conjunction with a single off-road/mobile equipment claim <ItemInfo>; however, <Watercraft> and <ItemInfo>, multiple <Watercraft>, or multiple <ItemInfo> are still not allowed to be reported within a single claim. <ACORD> <SignonRq>…</SignonRq> <ClaimsSvcRq>

<ClaimInvestigationAddRq>

<RqUID>…</RqUID>

<TransactionRequestDt>…</TransactionRequestDt>

<CurCd>…</CurCd>

<CodeList>……. </CodeList>

<Policy>……</Policy>

<ClaimsOccurrence>…. </ClaimsOccurrence>

<ClaimsParty>

<GeneralPartyInfo>.... </GeneralPartyInfo>

<ClaimsPartyInfo>.... </ClaimsPartyInfo>

</ClaimsParty>

<AdjusterParty>

<AdjusterPartyInfo>…</AdjusterPartyInfo>

</AdjusterParty>

<PropertyLossInfo>

<Watercraft>…</Watercraft>

</PropertyLossInfo>

</ClaimInvestigationAddRq>

</ClaimsSvcRq>

</ACORD>

The following elements are required per a boat property loss.

Data Element Location

@id ClaimInvestigationAddRq/ PropertyLossInfo id=” “

ItemTypeCd ClaimInvestigationAddRq/ PropertyLossInfo/ Watercraft/ ItemDefinition/ ItemTypeCd=”Watercraft”

Boat Year ClaimInvestigationAddRq/ PropertyLossInfo/ Watercraft/ ItemDefinition/ ModelYear

Boat Make ClaimInvestigationAddRq/ PropertyLossInfo/ Watercraft/ ItemDefinition/ Manufacturer

HIN ClaimInvestigationAddRq/ PropertyLossInfo/ Watercraft/ ItemDefinition/ SerialIdNumber

35

Mobile Equipment

In the case of an Off-Road or Mobile Equipment claim, the following would be the minimum. Off-Road or Mobile Equipment is defined as vehicles or equipment that is not licensed for road-use. If the vehicle is licensed for road-use, it should be reported as a vehicle claim as above.

1. Claims Party Aggregate 1 = the name, street address, city, state, and role code indicating the party as the Claimant and Insured; required to have its own Id for future reference.

2. AdjusterPartyInfo Aggregate = lists the loss type only being applied to the coverage and loss; refers back to PropertyLossInfo Aggregate.

3. PropertyLossInfo Aggregate = required to have its own Id for future reference; refers back to the Claimant and Insured’s ClaimsParty Id.

a. ItemInfo = lists the PIN, Make, and Year of the off-road or mobile equipment that the coverage and loss type are being applied to.

Note - A 1

st party general property claim <ClaimsSubjectInsuranceInfo> may be reported in conjunction with a

single boat policy claim <Watercraft>, OR <ClaimsSubjectInsuranceInfo> in conjunction with a single off-road/mobile equipment claim <ItemInfo>; however, <Watercraft> and <ItemInfo>, multiple <Watercraft>, or multiple <ItemInfo> are still not allowed to be reported within a single claim. <ACORD> <SignonRq>…</SignonRq> <ClaimsSvcRq>

<ClaimInvestigationAddRq>

<RqUID>…</RqUID>

<TransactionRequestDt>…</TransactionRequestDt>

<CurCd>…</CurCd>

<CodeList>……. </CodeList>

<Policy>……</Policy>

<ClaimsOccurrence>…. </ClaimsOccurrence>

<ClaimsParty>

<GeneralPartyInfo>.... </GeneralPartyInfo>

<ClaimsPartyInfo>.... </ClaimsPartyInfo>

</ClaimsParty>

<AdjusterParty>

<AdjusterPartyInfo>…</AdjusterPartyInfo>

</AdjusterParty>

<PropertyLossInfo>

<ItemInfo>

<ItemDefinition>… </ItemDefinition>

</ItemInfo>

</PropertyLossInfo>

</ClaimInvestigationAddRq>

</ClaimsSvcRq>

</ACORD>

The following elements are required per a mobile/off road equipment property loss.

Data Element Location

@id ClaimInvestigationAddRq/ PropertyLossInfo id=” “

ItemTypeCd ClaimInvestigationAddRq/ PropertyLossInfo/ Watercraft/ ItemDefinition/ ItemTypeCd=”MoblEquip”

Item Year ClaimInvestigationAddRq/ PropertyLossInfo/ ItemInfo/ ItemDefinition/ ModelYear

Make ClaimInvestigationAddRq/ PropertyLossInfo/ ItemInfo/ ItemDefinition/ ManufacturerCd

VIN or PIN ClaimInvestigationAddRq/ PropertyLossInfo/ ItemInfo/ ItemDefinition/ SerialIdNumber

36

Theft Recovery or Salvage Claims

If a vehicle, boat, or mobile equipment has been stolen and the insuring agency is reporting the theft recovery information, then the <InvestigationInfo> aggregate (including the <RecoveryInfo> aggregate) should be added to the aggregates reported above within the <ClaimInvestigationAddRq> of the claim. Vehicle Theft Recovery or Salvage <ACORD>

… </AutoLossInfo>

<InvestigationInfo> <RecoveryInfo>…</RecoveryInfo> <SalvageInfo>…</SalvageInfo> </InvestigationInfo> </ClaimInvestigationAddRq>

</ClaimSvcRq>

</ACORD>

If a vehicle, boat, or mobile equipment has been salvaged and the insuring agency is reporting the salvage information, then the <InvestigationInfo> aggregate (including the <SalvageInfo> aggregate should be added to the aggregates reported above within the </ClaimInvestigationAddRq> of the claim.

Boat or Mobile Equipment Theft Recovery or Salvage <ACORD> … </PropertyLossInfo>

<InvestigationInfo> <RecoveryInfo>…</RecoveryInfo> <SalvageInfo>…</SalvageInfo> </InvestigationInfo> </ClaimInvestigationAddRq>

</ClaimSvcRq>

</ACORD>

The following elements are required if theft recovery information is being reported by the insuring organization These are in addition to the Boat Loss Elements, Mobile Equipment Loss Elements, or Vehicle Loss Elements provided above.

Data Element Location

Recovery Agency ClaimInvestigationAddRq/ ClaimsPartyInfo (ACORD Role Code = RecoveringAgency)

Condition of Recovered Vehicle ClaimInvestigationAddRq/ InvestigationInfo/ RecoveryInfo/ RecoveryStatusCd

Recovery Date ClaimInvestigationAddRq/ InvestigationInfo/ RecoveryInfo/ RecoveryDt

Recovery Location State ClaimInvestigationAddRq/ InvestigationInfo/ RecoveryInfo/ Addr/State

The following elements are required if salvage information is being reported by the insuring organization. These are in addition to the Boat Loss Elements, Mobile Equipment Loss Elements, or Vehicle Loss Elements provided above.

Data Element Location

Salvage Buyer ClaimInvestigationAddRq/ ClaimsPartyInfo (Either refers to Owner as salvage buyer or creates separate ClaimsPartyInfo with Salvage Buyer information using ACORD Role Code = SalvageBuyer)

Date of Salvage ClaimInvestigationAddRq/ InvestigationInfo/ SalvageInfo/ SalvageDt

Owner Retaining Salvage Ind ClaimInvestigationAddRq/ InvestigationInfo/ SalvageInfo/OwnerRetainingSalvageInd

37

Replacement/ Update Requests

The Key Fields for locating an original claim in the database when submitting a Replacement or Update record are <PolicyNumber>, <AgencyId>, <InsurerId>, and <LossDt>. ISO ClaimSearch uses these fields as a "key" to locate the Initial claim in the database. It is imperative when submitting a Replacement or Update record that these fields are exactly as they were on the Initial claim. If they are not, the claim will reject with the error "Initial Claim Not Found". Note - Customers may elect to send only replacements, only updates or a combination of both types of records.

Replacement Claims

A Replacement Request may be sent in which the entire claim is sent again indicating that it is to replace an existing claim on the database. A Replacement will completely overlay the existing record(s) in the database and will automatically perform another search of the database. Replacements do not replace the ISO FileNumber or the ISO Received Date; nor do they change the timeframe of the Automatic Update Reports. For Replacement Claims, the complete claim information should be sent with the <ReplacementInd> set equal to 1 (True). It is important to remember that submission of a Replacement must include all data elements and claim fields a carrier initially reported unless the intent is to delete certain fields or data elements from the ISO ClaimSearch record (See Deleting Information in Fields). Replacements use all the same aggregates, elements and Schema hierarchy as Initial Reports. On a Replacement, if you wish to update information but do not wish to perform a search, please use the <SuppressMatchInd> on the <ClaimInvestigationAddRq> for the entire claim or on the <PartyInvestigationInfo> for specific ClaimsParty’s. When searches are suppressed at the claim level, you will not receive an asynchronous Response with a message status “Success”. You will, however, receive any Error Reports in the case of a Format or Data errors. Replacement Structure <ACORD> <SignonRq>…</SignonRq> <ClaimsSvcRq>

<ClaimInvestigationAddRq>

<RqUID>…</RqUID>

<TransactionRequestDt>…</TransactionRequestDt>

<CurCd>…</CurCd>

<CodeList>……. </CodeList>

<ReplacementInd>1</ReplacementInd>

<SupressMatchInd>…</SupressMatchInd>

<Policy>……</Policy>

<ClaimsOccurrence>…. </ClaimsOccurrence>

<ClaimsParty>

<GeneralPartyInfo>.... </GeneralPartyInfo>

<ClaimsPartyInfo>.... </ClaimsPartyInfo>

<ClaimsInjuredInfo> ...... </ClaimsInjuredInfo>

</ClaimsParty>

<AdjusterParty>…</AdjusterParty>

</ClaimInvestigationAddRq>

</ClaimsSvcRq>

</ACORD>

Required Elements – Replacement Reports For Replacement claims, all the elements that are required on the Initial claim must be present, plus the field listed below.

Data Element Location

Report Type ClaimInvestigationAddRq/ ReplacementInd (Indicator = 1)

38

Update Claims

An Update Request allows companies to send some key identifiers on a claim with the specific sections of the claim to be updated. Unlike Replacements, Update Requests do not perform searches. After an Update Request is sent, if a search is desired, a Re-Search Request should be sent after a 1 – 1½ min. delay to allow for the processing of the Update. Updates do not replace the ISO FileNumber, the ISO Received Date, or any information entered or updated by the website; nor do they change the timeframe of the Automatic Update Reports. If a specific section of an existing claim needs to be updated, this can be accomplished using the <com.iso_Update> aggregate, the key fields listed below, and the section of the claim to be updated. The following actions may be completed using the <com.iso_UpdateInd> (UpdateInd) number shown below:

1. Add An Involved Party 2. Update An Involved Party 3. Update An Amount Or Status For A Coverage 4. Request A New Search To Be Completed On Claim or Involved Party(Re-Search Request) 5. Change Key Field Identifiers 6. Add A Service Provider To An Involved Party

A claim update will not result in another search for the UpdateInds 1, 2, 3, 5, or 6. These Update requests do not provide an asynchronous Response with a <MsgStatus> “Success”. Only claim update requests with an UpdateInd 4, provides a “Success” asynchronous Response message. All update requests will continue to receive any Error Reports in the case of a Format or Data errors. XML Structure and Required Elements

The sections listed below as “If Applicable,” only need to be sent if that particular section of the claim is being updated. Also, there are additional elements required by the ACORD specification, not listed in this section. In addition, due to the nature of ACORD XML, there are certain identifiers and references that ISO requires to properly interpret the XML. These have been marked as “Required” in their proper context in a later section of this manual. Adding an Involved Party <com.iso_UpdateInd>1</com.iso_UpdateInd>

This can be used to add a new involved party to an existing claim, including all associated AKA, service provider, additional claimants for Medicare Section 111 reporting and coverage information without resending entire claim. The <com.iso_Update> aggregate, the key field identifiers (PolicyNumber, AgencyId, InsurerId, LossDt), and all information for the involved party must be sent including all AKAs, service providers, additional claimants, ClaimsPartyRelationships and coverage information (ClaimsInjuredInfo, AutoLossInfo, and/or PropertyLossInfo; and AdjusterPartyInfo). NO ECHO OR MATCH INFORMATION WILL BE PROVIDED. NO CMS WARNING MESSAGES WILL BE GENERATED. ONLY REJECTION INFORMATION WILL BE PROVIDED. Below is an example of the XML Structure for Adding an Involved Party. Note - the appropriate loss aggregates must be sent for the type of claim as well as all ID’s and references necessary for XML structure. <ACORD> <SignonRq>…</SignonRq> <ClaimsSvcRq> <RqUID>…</RqUID> <ClaimInvestigationAddRq> <RqUID>…</RqUID> <TransactionRequestDt>…</TransactionRequestDt> <CurCd>…</CurCd> <CodeList> …</CodeList> <com.iso_Update> <com.iso_UpdateInd>1</com.iso_UpdateInd> </com.iso_Update> <Policy>…</Policy> <ClaimsOccurrence>

39

<ItemIdInfo> <InsurerId>…</InsurerId> </ItemIdInfo> <LossDt>…</LossDt> </ClaimsOccurrence> <ClaimsParty> <GeneralPartyInfo>…</GeneralPartyInfo> <ClaimsPartyInfo> <ClaimsPartyRoleCd>…</ClaimsPartyRoleCd> </ClaimsPartyInfo> <ClaimsInjuredInfo>…</ClaimsInjuredInfo> </ClaimsParty> <AdjusterParty> <AdjusterPartyInfo>…</AdjusterPartyInfo> </AdjusterParty> </ClaimInvestigationAddRq> </ClaimsSvcRq> </ACORD>

Required Elements for Adding an Involved Party

Update Indicator ClaimInvestigationAddRq/ com.iso_Update/ com.iso_UpdateInd (Indicator = 1)

Policy Number ClaimInvestigationAddRq/ Policy/ PolicyNumber

Policy Type ClaimInvestigationAddRq/ Policy/ LOBCd (true policy type or “unknown” are okay for updates only)

Insuring Company ID ClaimInvestigationAddRq/ Policy/ MiscParty/ ItemIdInfo/ AgencyId and ClaimInvestigationAddRq/Policy/MiscParty/MiscPartyRoleCd = “CarrierInsurer”

Claim Number ClaimInvestigationAddRq/ ClaimsOccurrence/ ItemIdInfo/ InsurerId

Date of Loss ClaimInvestigationAddRq/ ClaimsOccurrence/ LossDt

Claims Party Information ClaimInvestigationAddRq/ ClaimsParty

Claims Party Information for AKA (if applicable)

ClaimInvestigationAddRq/ ClaimsParty (rolecode = Alias)

Claims Party Information for Service Provider (if applicable)

ClaimInvestigationAddRq/ ClaimsParty (rolecode for doctor, lawyer, body shop, etc)

Claims Party Relationship (if applicable)

ClaimInvestigationAddRq/ ClaimsPartyRelationship (for either AKA or Service Provider)

Casualty Loss Info (If Applicable) ClaimInvestigationAddRq/ ClaimsParty/ ClaimsInjuredInfo

Property Loss Info (If Applicable) ClaimInvestigationAddRq/ PropertyLossInfo

Auto Loss Info (If Applicable) ClaimInvestigationAddRq/ AutoLossInfo

Coverage Type ClaimInvestigationAddRq/ AdjusterParty/ AdjusterPartyInfo/ CoverageCd

Loss Type ClaimInvestigationAddRq/ AdjusterParty/ AdjusterPartyInfo/ LossCauseCd

40

Updating an Involved Party <com.iso_UpdateInd>2</com.iso_UpdateInd>

This can be used to update existing information on an involved party on an existing claim in the database, including all associated AKA, service provider, additional claimants for Medicare Section 111 reporting and coverage information without resending entire claim. The entire involved party and ALL associated records that were originally submitted must be resent along with any new information being added. Otherwise the previous information will be overwritten with the information submitted following the <com.iso_Update> aggregate. The exception to this is if the information has been touched on our website, then the information cannot be overwritten using Update process, only changed. NO ECHO OR MATCH INFORMATION WILL BE PROVIDED. NO CMS WARNING MESSAGES WILL BE GENERATED. ONLY REJECTION INFORMATION WILL BE PROVIDED. Below is an example of the XML Structure for Updating a ClaimsParty. Note - the appropriate loss aggregates must be sent for the type of claim as well as all ID’s and references necessary for XML structure. <ACORD> <SignonRq>…</SignonRq> <ClaimsSvcRq> <RqUID>…</RqUID> <ClaimInvestigationAddRq> <RqUID>…</RqUID> <TransactionRequestDt>…</TransactionRequestDt> <CurCd>…</CurCd> <CodeList> …</CodeList> <com.iso_Update> <com.iso_UpdateInd>2</com.iso_UpdateInd> <com.iso_OriginalFields> <PersonName> <Surname>As it exists on the database</Surname> <GivenName>As it exists on the database</GivenName> <OtherGivenName>If it exists on the database</OtherGivenName> </PersonName> </com.iso_OriginalFields> </com.iso_Update> <Policy>…</Policy> <ClaimsOccurrence> <ItemIdInfo> <InsurerId>…</InsurerId> </ItemIdInfo> <LossDt>…</LossDt> </ClaimsOccurrence> <ClaimsParty> <GeneralPartyInfo>…</GeneralPartyInfo> <ClaimsPartyInfo> <ClaimsPartyRoleCd codelistref=”ClaimsPartyRoleCd”>CI</ClaimsPartyRoleCd> </ClaimsPartyInfo> </ClaimsParty> <ClaimsParty> <GeneralPartyInfo>…</GeneralPartyInfo> <ClaimsPartyInfo> <ClaimsPartyRoleCd>Alias</ClaimsPartyRoleCd> </ClaimsPartyInfo> </ClaimsParty> <ClaimsPartyRelationship> <ClaimsParty1 codelistref=”ClaimsPartyRoleCd”>CI</ClaimsParty1> <ClaimsParty2>Alias</ClaimsParty2> <ClaimsPartyRelationship> <AdjusterParty> <AdjusterPartyInfo>…</AdjusterPartyInfo> </AdjusterParty> <AutoLossInfo>…</AutoLossInfo> </ClaimInvestigationAddRq> </ClaimsSvcRq> </ACORD>

41

Required Elements for Updating an Involved Party

Data Element Location

Update Indicator ClaimInvestigationAddRq/ com.iso_Update/ com.iso_UpdateInd (Indicator = 2)

ClaimsParty Info ClaimInvestigationAddRq/ com.iso_Update/ com.iso_OriginalFields/ CommercialName OR /PersonName (as applicable)

Policy Number ClaimInvestigationAddRq/ Policy/ PolicyNumber

Policy Type ClaimInvestigationAddRq/ Policy/ LOBCd (true policy type or “unknown” are okay for updates only)

Insuring Company ID ClaimInvestigationAddRq/ Policy/ MiscParty/ ItemIdInfo/ AgencyId and ClaimInvestigationAddRq/Policy/MiscParty/MiscPartyRoleCd = “CarrierInsurer”

Claim Number ClaimInvestigationAddRq/ ClaimsOccurrence/ ItemIdInfo/ InsurerId

Date of Loss ClaimInvestigationAddRq/ ClaimsOccurrence/ LossDt

Claims Party Information ClaimInvestigationAddRq/ ClaimsParty

Claims Party Information for AKA (if applicable)

ClaimInvestigationAddRq/ ClaimsParty (rolecode = Alias)

Claims Party Information for Service Provider (if applicable)

ClaimInvestigationAddRq/ ClaimsParty (rolecode for doctor, lawyer, body shop, etc)

Claims Party Relationship (if applicable)

ClaimInvestigationAddRq/ ClaimsPartyRelationship (for either AKA or Service Provider)

Casualty Loss Info (If Applicable) ClaimInvestigationAddRq/ ClaimsParty/ ClaimsInjuredInfo

Property Loss Info (If Applicable) ClaimInvestigationAddRq/ PropertyLossInfo

Auto Loss Info (If Applicable) ClaimInvestigationAddRq/ AutoLossInfo (VehInfo/ VehIdentificationNumber may be required as a key field if multiple VINs are submitted on the same ClaimsParty. See Multiple Vehicle Reporting.)

Loss Type ClaimInvestigationAddRq/ AdjusterParty/ AdjusterPartyInfo/ LossCauseCd

Coverage Type ClaimInvestigationAddRq/ AdjusterParty/ AdjusterPartyInfo/ CoverageCd

42

Update an Amount or a Status for Coverage <com.iso_UpdateInd>3</com.iso_UpdateInd>

This can be used to update coverage amounts, payment amounts, or open/closed status of a claim without resending entire claim. NO ECHO OR MATCH INFORMATION WILL BE PROVIDED. NO CMS WARNING MESSAGES WILL BE GENERATED. ONLY REJECTION INFORMATION WILL BE PROVIDED. Below is an example of the XML Structure for updating an amount or status for a coverage. Note - the appropriate loss aggregates must be sent for the type of claim as well as all ID’s and references necessary for XML structure. The ClaimsPayment aggregates will vary depending on the type of payment being updated. Please see the ClaimsPayment aggregate for further details. <ACORD> <SignonRq>…</SignonRq> <ClaimsSvcRq> <ClaimInvestigationAddRq> <RqUID>…</RqUID> <TransactionRequestDt>…</TransactionRequestDt> <CurCd>…</CurCd> <CodeList>…</CodeList> <com.iso_Update> <com.iso_UpdateInd>3</com.iso_UpdateInd> <com.iso_OriginalFields> <PersonName> <Surname>As it exists on the database</Surname> <GivenName>As it exists on the database</GivenName> <OtherGivenName>If it exists on the database</OtherGivenName> </PersonName> </com.iso_OriginalFields> </com.iso_Update> <Policy>…</Policy> <ClaimsOccurrence> <ItemIdInfo> <InsurerId>…</InsurerId> </ItemIdInfo> <LossDt>…</LossDt> </ClaimsOccurrence> <ClaimsParty id="…" /> <AutoLossInfo id="…" ClaimsPartyRefs="…" > <VehInfo> <VehIdentificationNumber>…</VehIdentificationNumber> </VehInfo> </AutoLossInfo> <ClaimsPayment idref="…" ClaimsPartyRef="…"> <PaymentTypeCd>…</PaymentTypeCd> <ClaimsPaymentCovInfo> <CoverageCd>…</CoverageCd> <ClaimStatusCd>…</ClaimStatusCd> </ClaimsPaymentCovInfo> <TotalPaymentAmt> <Amt>…</Amt> </TotalPaymentAmt> </ClaimsPayment> </ClaimInvestigationAddRq> </ClaimsSvcRq> </ACORD>

43

Required Elements for Updating an Amount or Status for a Coverage

Data Element Location

Update Indicator ClaimInvestigationAddRq/ com.iso_Update/ com.iso_UpdateInd (Indicator = 3)

Claims Party Information ClaimInvestigationAddRq/ com.iso_Update/ com.iso_OriginalFields/ CommercialName

OR /PersonName (as applicable)

Policy Number ClaimInvestigationAddRq/ Policy/ PolicyNumber

Policy Type ClaimInvestigationAddRq/ Policy/ LOBCd (true policy type or “unknown” are okay for updates only)

Insuring Company ID ClaimInvestigationAddRq/ Policy/ MiscParty/ ItemIdInfo/ AgencyId and ClaimInvestigationAddRq/Policy/MiscParty/MiscPartyRoleCd = “CarrierInsurer”

Claim Number ClaimInvestigationAddRq/ ClaimsOccurrence/ ItemIdInfo/ InsurerId

Date of Loss ClaimInvestigationAddRq/ ClaimsOccurrence/ LossDt

ClaimsParty ID ClaimInvestigationAddRq/ ClaimsParty id=””

Casualty Loss Info (If Applicable) ClaimInvestigationAddRq/ ClaimsParty/ ClaimsInjuredInfo id=””

Property Loss Info (If Applicable) ClaimInvestigationAddRq/ PropertyLossInfo id=””

Auto Loss Info (If Applicable) ClaimInvestigationAddRq/ AutoLossInfo id=””

VIN (See Multiple Vehicle Reporting)

ClaimInvestigationAddRq/ AutoLossInfo/ VehInfo/ VehIdentificationNumber

Loss Type ClaimInvestigationAddRq/ AdjusterParty/ AdjusterPartyInfo/ LossCauseCd

Coverage Type ClaimInvestigationAddRq/ AdjusterParty/ AdjusterPartyInfo/ CoverageCd (For casualty and auto claims, please use the CoverageCd as submitted on the Initial. For property claims where coverage code is not required, use the code “PROP” to complete the update.)

Coverage Status (If Applicable) ClaimInvestigationAddRq/ ClaimsPayment/ ClaimsPaymentCovInfo/ ClaimStatusCd

Amount (if Applicable) ClaimInvestigationAddRq/ ClaimsPayment/

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Add a Service Provider to an Involved Party <com.iso_UpdateInd>6</com.iso_UpdateInd>

This can be used to add a service provider to an existing involved party. In this example, a Claimant and Insured (Role Code: CI) is the involved party and a Medical Doctor (Role Code: MD) is being added to the involved party. The <ClaimsParty> information for both parties (including role codes) and their relationship <ClaimsPartyRelationship> must be sent on the update, but no coverage or payment information is sent in this update request. If other sections of the same involved party need to be updated, then the Update to an Involved Party (indicator 2) should be used instead. NO ECHO OR MATCH INFORMATION WILL BE PROVIDED. NO CMS WARNING MESSAGES WILL BE GENERATED. ONLY REJECTION INFORMATION WILL BE PROVIDED. <ACORD > <SignonRq>…</SignonRq> <ClaimsSvcRq> <ClaimInvestigationAddRq> <RqUID>…</RqUID> <TransactionRequestDt>…</TransactionRequestDt> <CurCd>…</CurCd> <CodeList…</CodeList> <com.iso_Update> <com.iso_UpdateInd>6</com.iso_UpdateInd> </com.iso_Update> <Policy>…</Policy> <ClaimsOccurrence> <ItemIdInfo> <InsurerId>…</InsurerId> </ItemIdInfo> <LossDt>…</LossDt> </ClaimsOccurrence> <ClaimsParty> <GeneralPartyInfo> <NameInfo>…</NameInfo> <Addr>…</Addr> </GeneralPartyInfo> <ClaimsPartyInfo> <ClaimsPartyRoleCd>CI</ClaimsPartyRoleCd> </ClaimsPartyInfo> </ClaimsParty> <ClaimsParty> <GeneralPartyInfo> <NameInfo>…</NameInfo> <Addr>…</Addr> </GeneralPartyInfo> <ClaimsPartyInfo> <ClaimsPartyRoleCd>MD</ClaimsPartyRoleCd> </ClaimsPartyInfo> </ClaimsParty> <ClaimsPartyRelationship ClaimsParty1Ref="…" ClaimsParty2Ref="…"> <ClaimsPartyRole1Cd codelistref=”ClaimsPartyRoleCd”>CI</ClaimsPartyRole1Cd> <ClaimsPartyRole2Cd codelistref=”ClaimsPartyRoleCd”>MD</ClaimsPartyRole2Cd> </ClaimsPartyRelationship> </ClaimInvestigationAddRq> </ClaimsSvcRq> </ACORD>

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Required Elements to Add a Service Provider to Claims Party

Data Element Location

Update Indicator ClaimInvestigationAddRq/ com.iso_Update/ com.iso_UpdateInd (Indicator = 6)

Policy Number ClaimInvestigationAddRq/ Policy/ PolicyNumber

Policy Type ClaimInvestigationAddRq/ Policy/ LOBCd (true policy type or “unknown”)

Insuring Company ID ClaimInvestigationAddRq/ Policy/ MiscParty/ ItemIdInfo/ AgencyId and ClaimInvestigationAddRq/Policy/MiscParty/MiscPartyRoleCd = “CarrierInsurer”

Claim Number ClaimInvestigationAddRq/ ClaimsOccurrence/ ItemIdInfo/ InsurerId

Date of Loss ClaimInvestigationAddRq/ ClaimsOccurrence/ LossDt

ClaimsParty ClaimInvestigationAddRq/ ClaimsParty (involved party who is using the service provider)

ClaimsParty ClaimInvestigationAddRq/ ClaimsParty (service provider’s information)

Relationship of ClaimsParty and Service Provider

ClaimInvestigationAddRq/ ClaimsPartyRelationship

Re-Search Request

A Re-Search Request <com.iso_UpdateInd>4</com.iso_UpdateInd> provides the subscriber the ability to perform a search on a previously submitted claim. This feature searches without altering the original information. When filing a Re-Search, the PolicyNumber, AgencyId, InsurerId, and LossDt (the key fields) must be provided exactly as they appeared on the Initial claim. The System will use this "key" information to find your "Initial" claim in the database and perform another search. When sending a Re-Search, only the key fields listed below are required; no additional claim information should be sent. If a “key” field in an initial record was subsequently changed, to Re-Search the claim, the newest (i.e., changed) record with the revised key fields should be submitted (otherwise, an error message indicating the initial claim was not found will be generated). Open claims can be Re-Searched, prior to settlement, to check for reports on any claims occurring subsequent to their loss date. It is not recommended to send a Re-Search request within the first thirty days after an initiating auto claim is submitted; sixty days after an initiating property claim; or one year after an initiating casualty claim, since the System automatically searches claim reports during the prescribed time periods. As a guideline, in most cases, Re-Searching open Casualty claims for the first time 15 months after the Initial was sent, and then every six months thereafter up to settlement should be sufficient (See Automatic Update Reports). It is important to note that a Re-Search will not "re-activate" the period of providing Automatic Updates to the subscriber. IF SUCCESSFUL, ECHO AND MATCH INFORMATION WILL BE PROVIDED. CMS WARNING MESSAGES WILL BE GENERATED. AUTOMATIC UPDATES TO OTHER COMPANIES WILL BE GENERATED. IF REJECTED, ERROR INFORMATION WILL BE PROVIDED. Claim Level Research <ACORD>

<SignonRq>…</SignonRq> <ClaimsSvcRq> <RqUID>…</RqUID> <ClaimInvestigationAddRq> <RqUID>…</RqUID> <TransactionRequestDt>…</TransactionRequestDt> <CurCd>…</CurCd> <com.iso_Update> <com.iso_UpdateInd>4</com.iso_UpdateInd> </com.iso_Update> <SearchBasisCd>C</SearchBasisCd> <Policy>…</Policy> <ClaimsOccurrence>

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<ItemIdInfo> <InsurerId>…</InsurerId> </ItemIdInfo> <LossDt>…</LossDt> </ClaimsOccurrence> </ClaimInvestigationAddRq> </ClaimsSvcRq> </ACORD>

Involved Party Level Research <ACORD>

<SignonRq>…</SignonRq> <ClaimsSvcRq> <RqUID>…</RqUID> <ClaimInvestigationAddRq> <RqUID>…</RqUID> <TransactionRequestDt>…</TransactionRequestDt> <CurCd>…</CurCd> <com.iso_Update> <com.iso_UpdateInd>4</com.iso_UpdateInd> </com.iso_Update> <SearchBasisCd>I</SearchBasisCd> <Policy>…</Policy> <ClaimsOccurrence> <ItemIdInfo> <InsurerId>…</InsurerId> </ItemIdInfo> <LossDt>…</LossDt> </ClaimsOccurrence> <ClaimsParty> <GeneralPartyInfo> <NameInfo> <PersonName> <Surname>As it exists on the database</Surname> <GivenName>As it exists on the database</GivenName> <OtherGivenName>If it exists on the database</OtherGivenName> </PersonName> </NameInfo> </GeneralPartyInfo> </ClaimsParty> </ClaimInvestigationAddRq> </ClaimsSvcRq> </ACORD>

Required Elements for a Research Report

Data Element Location

Update Indicator ClaimInvestigationAddRq/ com.iso_Update/ com.iso_UpdateInd (Indicator = 4)

Search Basis Code ClaimInvestigationAddRq/ SearchBasisCd (C = Entire Claim; I = Individual)

Policy Number ClaimInvestigationAddRq/ Policy/ PolicyNumber

Policy Type ClaimInvestigationAddRq/ Policy/ LOBCd

Insuring Company ID ClaimInvestigationAddRq/ Policy/ MiscParty/ ItemIdInfo/ AgencyId and ClaimInvestigationAddRq/Policy/MiscParty/MiscPartyRoleCd = “CarrierInsurer”

Claim Number ClaimInvestigationAddRq/ ClaimsOccurrence/ ItemIdInfo/ InsurerId

Date of Loss ClaimInvestigationAddRq/ ClaimsOccurrence/ LossDt

ClaimsParty Name (If Individual Search)

ClaimInvestigationAddRq/ ClaimsParty/ GeneralPartyInfo/ NameInfo/ CommlName

Or / PersonName (As Applicable)

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Changing Key Field Information

The required fields for locating an original claim in the database are the PolicyNumber, AgencyId, InsurerId, and LossDt. ISO ClaimSearch uses these fields as a "key" to locate the Initial claim in the database. Subscribers may change key fields on previously submitted claims. To change these fields, the subscriber must submit both the original claim information previously sent to the database and the information to replace the desired fields in the regular claims format. A Key Field Update <com.iso_UpdateInd>5</com.iso_UpdateInd> should be sent containing the exact "key" field information that was originally submitted in the Original Fields aggregate <com.iso_OriginalFields>. This is followed by the regular claim aggregates for the same fields containing either the new information, or a duplicate of the original data to indicate no changes are to be made in that field. NO ECHO OR MATCH INFORMATION WILL BE PROVIDED. NO CMS WARNING MESSAGES WILL BE GENERATED. ONLY REJECTION INFORMATION WILL BE PROVIDED. ALL FUTURE REPLACEMENT OR UPDATE REQUESTS FOR THIS CLAIM SHOULD CONTAIN THE NEW KEY. <ACORD> <SignonRq>…</SignonRq> <ClaimsSvcRq> <RqUID>…</RqUID> <ClaimInvestigationAddRq> … <CodeList…</CodeList> <com.iso_Update> <com.iso_UpdateInd>5</com.iso_UpdateInd> <com.iso_OriginalFields> <com.iso_KeyFields> <PolicyNumber>Original Policy Number</PolicyNumber> <ItemIdInfo> <AgencyId>Original AgencyId</AgencyId> <InsurerId>Original Claim Number</InsurerId> </ItemIdInfo> <LossDt>Original Loss Date</LossDt> </com.iso_KeyFields> </com.iso_OriginalFields> </com.iso_Update> <Policy> <PolicyNumber>New Policy Number</PolicyNumber> <LOBCd>Original Policy Type</LOBCd> <MiscParty> <ItemIdInfo> <AgencyId>New AgencyId</AgencyId> </ItemIdInfo> <MiscPartyInfo> <MiscPartyRoleCd>CarrierInsurer</MiscPartyRoleCd> </MiscPartyInfo> </MiscParty> </Policy> <ClaimsOccurrence> <ItemIdInfo> <InsurerId>New Claim Number</InsurerId> </ItemIdInfo> <LossDt>New Loss Date</LossDt> </ClaimsOccurrence> </ClaimInvestigationAddRq> </ClaimsSvcRq></ACORD>

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Required Elements for Changing Key Fields

Data Element Location

Update Indicator ClaimInvestigationAddRq/ com.iso_Update/ com.iso_UpdateInd (Indicator = 5)

Original Policy Number ClaimInvestigationAddRq/ com.iso_Update/ com.iso_OriginalFields/ com.iso_KeyFields/ PolicyNumber

Original Insuring Company ID ClaimInvestigationAddRq/ com.iso_Update/ com.iso_OriginalFields/ com.iso_KeyFields / ItemIdInfo/ AgencyId

Original Claim Number ClaimInvestigationAddRq/ com.iso_Update/ com.iso_OriginalFields/ com.iso_KeyFields/ ItemIdInfo/ InsurerId

Original Date of Loss ClaimInvestigationAddRq/ com.iso_Update/ com.iso_OriginalFields/ com.iso_KeyFields/ LossDt

New Policy Number ClaimInvestigationAddRq/ Policy/ PolicyNumber

Original Policy Type ClaimInvestigationAddRq/ Policy/ LOBCd (cannot change Policy Type using Update Request)

New Insuring Company ID ClaimInvestigationAddRq/ Policy/ MiscParty/ ItemIdInfo/ AgencyId and ClaimInvestigationAddRq/Policy/MiscParty/MiscPartyRoleCd = “CarrierInsurer”

New Claim Number ClaimInvestigationAddRq/ ClaimsOccurrence/ ItemIdInfo/ InsurerId

New Date of Loss ClaimInvestigationAddRq/ ClaimsOccurrence/ LossDt

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Special Programming Notes

This section is dedicated to the nuances of programming. These are details that should be kept in mind as you design and develop your system to interact with ISO ClaimSearch. We have consolidated them into a single section for easy reference back to whenever you need them. Some of these apply only to Initial or Replacement Requests. Some apply only to Update Requests. Some apply to ALL types of Requests. Please read through this section carefully to see what applies to section you are programming. They are listed in alphabetical order.

ClaimInvestigationAddRq/Rs RqUID

For Initial and Replacement claims, ISO ClaimSearch will store the ClaimInvestigationAddRq/RqUID and return it on the Response as the ClaimInvestigationAddRs/RqUID to aid members in matching Request with Response. This will occur regardless of whether the Response is a “Success” or “Reject”. For all requests that use the <com.iso_Update> aggregate which includes both Update Requests and Research Requests, the ClaimInvestigationAddRq/RqUID is NOT stored and returned. If an Update Request is successful, there is no Response returned. If a Research is requested successfully, then the search process will return the last successfully submitted ClaimInvestigationAddRq/RqUID as it exists on the database.

Claim Level Reporting Vs. Exposure Level Reporting

ISO ClaimSearch designed our Universal Format system as a means to get away from exposure level reporting. It was named “Universal” as it combined all the elements of a single claim into a single transaction to ISO, allowing for multiple claimants and coverages to be reported at once. The system is designed to search multiple searchable fields for each claimant on the claim and bring back a single match report that contains the matches for all claims. When there is activity on the system that matches against your claim, ISO ClaimSearch provides an automatic update to your system for the claim in its entirety. When you update a portion of the claim, the system will search against the claim in its entirety by default, or only on the sections that you indicate. With exposure level reporting, ISO ClaimSearch has found several issues that have adversely impacted customers who choose to do this type of reporting. The first is that while the claimant and coverage might change from claim to claim, the overall claim details and insured information do not. Therefore it is often the case that the different exposures create matches against themselves. This creates extra “noise” for the adjusters as they are required to sort through their own company’s claims to find other matching claims. If there are enough matches in the system and a particular claimant maxes out at 25 claims, they could be missing out on matches if their own company’s reports are filling up many of the 25 slots per claimant. When an automatic update matches against the insured, every exposure on the claim will receive an automatic update. Again this creates extra “noise” for the adjusters as they will have multiples of the same report for a single claim. For many companies that have chosen to go this route, ISO ClaimSearch has received many complaints from users about the excessive reports they are receiving. Unfortunately, it is a case of “system working as designed” and we have to direct the users back to their own development team to state that this is not what they had in mind. Finally when other companies match against your claims, or are using fraud investigation tools, an insured with 5 claimants on the claim has now moved from a single claim with 5 claimants, to appearing as if the insured has 5 separate claims against the policy. This throws off any claims scoring products as the computer systems will count it as multiple claims indicating that your insured is more fraudulent than they really are, possibly flagging them in the companies you match against. For all of these reasons, ISO ClaimSearch is no longer allowing customers to move into Production with exposure level reporting. If a company is already reporting exposure level reporting, they will be asked to change to claim level reporting during their next system upgrade.

Data Editing Rules

Below are some of the general rules to follow for reporting data. Appendix C contains further information on Data Edits and Error Codes. Please contact ISO ClaimSearch for a list of all values considered to be invalid for the name, address, numeric, claim number, and license plate fields. The aggregates contain Usage information which can be interpreted as follows:

Required – The claim will be rejected if data is not present and in the right format (e.g., the Name

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validation rules) Optional – The claim will not be rejected if data is not present. If data is not in the right format or is on

the invalid list, it will be blanked out and continue processing the claim. Request Only – This element is only present on the Request sent from the member to ISO

ClaimSearch. Response Only – This element is only present on the Response sent from ISO ClaimSearch to the

member company. Max # - This element may be repeated up to the maximum number shown on this element.

XML has a special set of characters that cannot be used in normal XML strings. These characters

are: 1. & - &amp; 2. < - &lt; 3. > - &gt; 4. " - &quot; 5. ' - &#39;

Invalid: <Organization>IBM & Microsoft</Organization> Valid: <Organization>IBM &amp; Microsoft</Organization> It has also been found that other special characters will have issues within the XML processing as the encoding of the claims data transfers across several different platforms in the course of processing. It is best to omit all special characters, or to use HTML escapes for special characters if omission is not possible.

N vs. A/N Field Type- The Input record types reflect the Type of data expected to be sent by customers for best data quality purposes. The Output records however, require a broader interpretation as a claim submitted in Universal Format may match data from a legacy format or a system whose data input is not within ISO’s control. For example, we ask that all dates be submitted as Numeric only on input MMDDYYYY; however it is possible to receive back a Date of Death from SSA information that only includes Month and Year or just Year with spaces in the other positions. Therefore a field may be Numeric only on Input, but Alphanumeric on Output for these reasons. The fields that have been adjusted in this way are shaded gray within the record layouts themselves, just for this version of the manual, so that customers may make sure that their system can handle the data that may be returned.

ISO ClaimSearch performs a duplicate check on Initial Claims and will reject claims with the same <PolicyNumber>, <AgencyId>, <InsurerId>, and <LossDt>.

Numeric fields containing no data may be reported as blanks, or zero filled. Numeric fields containing data should be right justified with left zero filled. Date fields must be either blank or contain a valid date format. Dollar amounts may not be zero filled.

Dollar amounts must be reported using whole dollars (except for the amounts on the <com.iso_CovInfo1>

aggregate which should be reported with dollars and cents). The following are editing rules for the name fields (Claimant Name, Insured Name, Alias Name, etc.).

Name fields should contain names, not other information.

The Claimant's Last Name field must contain at least two letters.

The Claimant's First Name field must contain at least one letter.

Abbreviations or substitutions such as: UNKNOWN, UNK, N/A, etc. will not be accepted by the system (see Edit List in Appendix C).

"Informational" entries such as: DAUGHTER, SAME, NONE, etc. will not be accepted by the system.

Special characters except for apostrophe ( ‘ ), hyphen (-), or ampersand (&), should not be sent in the name field.

When reporting AKA (Also Known As) and Prior Address information associated with an involved party, you

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should report each appropriate section of the record completely; i.e. if reporting an AKA name, submit the entire name (business or last & first); for a prior address, include street, city, and state. NOTE – ISO cross-searches all names and addresses submitted on an involved party in all combinations. It is therefore not necessary to repeat the name of the AKA if it has not changed from one address to another. Conversely, if the name has changed while the address has remained the same, it is also not necessary to report the address twice.

When reporting Claim and Policy Numbers, please do not include any spaces, dashes or other special

characters. As part of the processing of claims, spaces, dashes, and special characters will be removed when the claim is added to the ISO ClaimSearch database.

Deleting Information in Fields

System to System Changes Customers may delete the information in any field with the exception of any required fields or fields added or updated via the ISO ClaimSearch website. To systematically delete the information in a non-required field, submit a replacement record where the field is blank or filled with zeroes. Required fields cannot be deleted, but may be changed. To delete an entire claim record, users must contact ISO ClaimSearch Customer Support. (info.claimsearch@iso.com).

Entering “Invalid” Names

ISO ClaimSearch maintains a list of “names” that are considered to be invalid, such as NA, UNKNOWN, UNK, NO, etc., because they are usually entered when complete information is not available. We believe the edits are necessary to prevent incorrect data from being added to the database. However, we do realize that there are occasions when one of these entries is the individual’s real name. If your claim rejects for an invalid name and you have verified that it is correct, you may enter parentheses around the name, for example, (NA), in order to get the name into the database. Any claimant name, insured name, AKA name or additional claimant name entered with parentheses around the name will now be accepted into the system. The parentheses will be dropped when the claim is added to the database and will not display on any ISO formatted reports. Any future replacements or updates of this name must also contain the parentheses around the name. These names may be entered through your automated system, if you have the capability of doing so, or may be entered through the ISO ClaimSearch website. NOTE: This process should be used only when you have verified the name. ISO randomly performs audits to check for data quality issues. If we suspect that the new process is being used just to bypass edits, you will be contacted.

IMPORTANT NOTICE REGARDING UPDATING CLAIMS VIA THE CLAIMSEARCH WEBSITE

If your company reports a claim through your system-to-system interface, you may choose to do all updates to the claim electronically through your system or users may go to the ClaimSearch website to update the claim. In the past, if fields or parties were added via the web and then a system replacement or update was sent with those fields or parties missing, the fields that were entered via the web were replaced with spaces. In order to not lose the updated information entered via the web, ClaimSearch will no longer blank out fields or parties reported via the web when a system replacement or update is sent without that information. We assume that if a user entered a field or party via the web, they did so intentionally and wouldn’t want the information to be eliminated by a subsequent system transmission. Claims that fall into this category are now subject to “Web Overlay” rules. Per these rules, subsequent actions on the same claim by the system-to-system (STS) interface will:

1. Allow the STS to change data within a field, but not blank out a value. 2. Require that each party reported via STS must match name fields (business name or first, middle, last

names) and role codes EXACTLY in order to complete changes, otherwise the system will assume a new party is being added.

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3. Require that if data needs to be removed on a claim, then a new web update must be entered to remove the value.

4. Cause the Web Overlay Ind, <com.iso_WebOverlayInd> to return as “Y” to indicate the claim has been touched on the web and information in the Echo portion of the match report may be different than what was on the Input records submitted via STS.

IMPORTANT NOTICE REGARDING UPDATE REQUESTS AND CMS MEDICARE REPORTING

If your company is required to report the RRE code on each record because you are registered with multiple RREs, you must replace your claim to add the RRE Code since the code cannot be added through the Update process, otherwise, your claim will not be reported to CMS. If your company only uses one RRE code, this action is not necessary. Also, Replacements are preferable vs. Update Records because the Warning Messages for Missing CMS Required Fields can only be provided on Initials and Replacements; not on Update or Research records.

Miscellaneous Text Fields <RemarkText>

Companies should utilize the Miscellaneous Text Field (ClaimInvestigationAddRq/RemarkText with @idref) and associate it using the appropriate ids/idrefs (ClaimsOccurrence, ClaimsParty [limited to 5 bytes], ClaimsInjuredInfo, AutoLossInfo, and/or PropertyLossInfo) to assist them in the internal distribution of their reports or for identification of the claim in Data Error Responses. These fields are 20 bytes except where noted and will not be altered or compressed in any fashion by ISO. Each will be returned exactly as it was submitted as part of the echo on the Response. These fields will also be returned as part of the Key Elements for XML Data Errors. These fields are NOT displayed to other member companies in their Match Reports.

Minimizing Replacement and Update Rejections

When reporting the Claim Number <InsurerId> and Policy Number <PolicyNumber>, it is important to use your actual claim and policy number. Any identifiers that may change (e.g. adjuster's initials, desk location, etc.) should be placed in the <RemarkText> of the <ClaimInvestigationAddRq>. The information in the <RemarkText> will be reported back to you to help with distribution of reports within your office. If you do not submit the Claim Number <InsurerId> and Policy Number <PolicyNumber> exactly as it was originally submitted, your Replacements, Updates, and Re-Searches will reject. When submitting a Replacement, Update or Re-Search, it is imperative you use the same <PolicyNumber>, <AgencyId>, <InsurerId>, and <LossDt> as they were originally submitted and exist in the database. The System will use this "key field" information to locate your Initial claim in the database and will either update the information or perform another search, as appropriate. If a “key” field on an initial claim was subsequently changed, then the newest (i.e. changed) version with the key fields should be submitted. If you have any questions regarding the above or would like ISO staff to research potential problems that your company may encounter based on previous filings, please contact your ISO ClaimSearch Testing Representative (see Who to Call).

Multiple Vehicle Reporting

Initial and Replacements - Multiple vehicles may be reported for a single ClaimsParty with the same coverage and loss types, however they must have unique VIN numbers or the claim will reject. For Third Party Claimants, where VIN is not normally required for a single vehicle, the VIN will become required in the event of multiple vehicles reported for the same ClaimsParty. Up to 100 VINs may be reported for a single ClaimsParty. Updates to a Single Vehicle Claim - When sending <com.iso_UpdateInd>=1, 2, or 3 on a claim that has a single VIN for each ClaimsParty, VIN is not required. The claim will be updated based on involved party, coverage type, and loss type. Updates to a Multiple Vehicle Claim - When sending <com.iso_UpdateInd>=1, 2, or 3 on a claim that has a multiple VINs for a single ClaimsParty, you must indicate which vehicle record the update is for by providing the VIN of the vehicle, even if the ClaimsParty is a third party claimant. The claim will be updated based on involved party, coverage type, loss type, and VIN.

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NOTE – When sending <com.iso_UpdateInd>=3 to update an amount or status for a ClaimsParty that has multiple vehicles, the VIN field becomes required. It must be an exact match of the previously submitted VIN on the database or the update will be rejected for “Initial Claim Not Found”.

No Coverage/ No Loss Type

For customers who wish to report vehicle information on a liability claim when there are no vehicle coverages to be reported, ISO has added the ability to allow you to report an AutoLossInfo aggregate with the appropriate vehicle information (VIN is the only required field), and you will be able to choose a new coverage and loss type (NCVG/NLOS) to indicate that no vehicle coverage is being reported for the claim. When reporting the claim, you would report the liability information on a ClaimsInjuredInfo with liability coverage and loss type, and the VIN and any other information on the vehicle on the AutoLossInfo with NCVG/NLOS type. A ClaimsInjuredInfo aggregate MUST be associated with the same ClaimsParty aggregate as the AutoLossInfo with NCVG/NLOS or the claim will be rejected with one of the two new error codes listed below. This is an optional type of reporting and is not required to be programmed by any company. Please note that this has not yet been added as an option on the ISO ClaimSearch website for Claims Reporting. It will be added as a future enhancement. The following policy types will allow such reporting; BOAT – Boat CAPP – Commercial Auto CCGL – Commercial General Liability CFRM – Commercial Farmowners COMR – Commercial Ocean Marine CLBO – Commercial Business Owners CPMP – Commercial Multi-Peril OLIB – Other Liability PAPP – Personal Auto PLIB – Personal Liability PLMA – Personal Liability Marine PPFM – Personal Property Farmowners PPHO – Personal Property Home Owners PPMH - Personal Property Mobile Home UMBR – Umbrella WCEL – Workers’ Comp & Employers Liability WCMA – Workers’ Comp Marine Two new error codes have also been added to Appendix C:

UV0117 – Coverage/loss types NCVG/NLOS must have an associated UC01 record (ClaimsInjuredInfo aggregate)

UV0118 – Coverage type NCVG cannot be submitted for this policy type.

Physical Risk, Mailing Address, and SIU Claim Level Elements

The following elements represent one of the few areas in the XML programming where data in the Request and the same data in the Response are in two different aggregates. See below for the proper Request/Response mapping. Request Mapping:

Data Element Location

Physical Risk Address Policy/ MiscParty/ GeneralPartyInfo/ Addr (AddrTypeCd=”PhysicalRisk”)

Mailing Risk Address Policy/ MiscParty/ GeneralPartyInfo/ Addr (AddrTypeCd=”MailingAddress”)

SIU Company Name Policy/ MiscParty/ GeneralPartyInfo/ NameInfo/ CommlName/ CommercialName

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SIU Investigator Personal Name Policy/ MiscParty/ GeneralPartyInfo/ NameInfo/ PersonName

SIU Investigator Business Phone Policy/ MiscParty/ GeneralPartyInfo/ Communications/ PhoneInfo (CommunicationUseCd=”Business”)

SIU Investigator Cell Phone Policy/ MiscParty/ GeneralPartyInfo/ Communications/ PhoneInfo (CommunicationUseCd=”Cell”)

Claim Associated with Insurer Fraud Ring ClaimsOccurrence/ com.iso_InsurerFraudRingInvestigation

Response Mapping:

Data Element Location

Physical Risk Address Policy/ MiscParty/ com.iso_SIUInfo/ GeneralPartyInfo/ Addr (AddrTypeCd=”PhysicalRisk”)

Mailing Risk Address Policy/ MiscParty/ com.iso_SIUInfo/ GeneralPartyInfo/ Addr (AddrTypeCd=”MailingAddress”)

SIU Company Name Policy/ MiscParty/ com.iso_SIUInfo/ com.iso_CommlName

SIU Investigator Personal Name Policy/ MiscParty/ com.iso_SIUInfo/ com.iso_SurName; com.iso_GivenName; com.iso_OtherGivenName

SIU Investigator Business Phone Policy/ MiscParty/ com.iso_SIUInfo/ com.iso_SIUPhoneInfo (CommunicationUseCd=”Business”)

SIU Investigator Cell Phone Policy/ MiscParty/ com.iso_SIUInfo/ com.iso_SIUPhoneInfo (CommunicationUseCd=”Cell”)

Claim Associated with Insurer Fraud Ring Policy/ MiscParty/ com.iso_SIUInfo/ com.iso_InsurerFraudRingInvestigation

Replacement and Re-Search Records from "Other Offices"

Some subscribers may wish to automatically change the AgencyId on a claim record whenever a change is submitted on a claim. This, in effect, will transfer the claim to whichever office submitted the change. In XML Format, this can be accomplished two ways: If submitting the change as a Replacement Request, first send a Changing Key Fields Update which will overwrite the existing AgencyId in the database. The Update should be followed by the Replacement Request containing the new office information in the AgencyId after a 1-1½ minute delay. This will automatically generate output to the new office. If submitting the change as an Update Request, first send a Changing Key Fields Update which will overwrite the existing AgencyId in the database. To receive output on the change, submit a Re-Search Request after a 1-1½ minute delay to generate a new search that will produce output to the new office.

Searchable Elements

In addition to the required fields listed above, it is strongly encouraged that you include other optional information that can enhance your search results. The fields listed below can be very beneficial when performing searches for prior claims histories. For example, use of a claimant’s Social Security Number will automatically generate a wider database search for the claimant, as it is a more unique identifier and can be searched more readily within the system. The following fields are all optional, but will be searched in addition to the required fields if provided on a searchable <ClaimsParty>. Alias (AKA) Names and Addresses Date of Birth Driver’s License Number and State Social Security Number (SSN), if individual** License Plate Number and State Zip Code Home Phone Number Cell Phone Number Pager Number + PIN Email Address **Social Security Number may display as a Reason for Match even if no SSN is provided on the claim due to

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the Append-DS Optional Service. Please see the Append-DS section of the manual for further information. Location of Loss Search – One of the Match Reason Codes indicates that the claim matched due to the location of loss on the claims being similar. This search is only performed on claims with a <PropertyLossInfo> and the loss type is not 'BURG', 'LOBG', 'MYST', 'ROBB', or 'THFT’. Inclusion of a zip code on the Location of Loss address will further limit the search to matching on claims that also include the same zip code. General Searching Rules: <ClaimsParty> are searched based on their role on the claim and the coverage records associated with them. A <ClaimsParty> with an Involved Party role code may match against other Claims Parties with an Involved Party role code or “Alias” role code. Please see Appendix B – Role Codes for additional information on the roles and coverage records requirements. A <ClaimsParty> with an “Alias” role code is only searched if the associated <ClaimsParty> with an Involved Party role code is searched. Then, all name and address combinations between the Involved Party and Alias are searched. It is not necessary to repeat names and addresses as it will only cause additional searches on the same criteria. An Alias <ClaimsParty> may match against Involved Party <ClaimsParty> information or other Alias <ClaimsParty> aggregates. A <ClaimsParty> with a Service Provider Role is only searched if the claim involves general property <PropertyLossInfo><ClaimsSubjectInsuranceInfo> and the role code is CO, FM, LP, or SM. A “searchable” Service Provider may match against <ClaimsParty> aggregates with Involved Party role codes only. NOTE - ONLY THE FIRST 99 <ClaimsParty> AGGREGATES ON A CLAIM WILL BE SEARCHED, REGARDLESS OF ROLE CODE BASED SOLELY ON THE ORDER PROVIDED ON THE CLAIM.

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SYSTEM OUTPUT (RECEIPT AND RESPONSE)

Receipt (Acknowledgement)

Upon successful submission, an immediate receipt will be returned to the member’s outgoing IPA. No claims data is sent in the receipt, just the information below where the <MsgStatus> is “ResponsePending.” <ACORD> <Status> <StatusCd>0</StatusCd> <StatusDesc>Success</StatusDesc> </Status> <SignonRs> <Status> <StatusCd>0</StatusCd> <StatusDesc>Sign on was successful</StatusDesc> </Status> <CustId> <SPName>iso.com</SPName> <CustLoginId>…</CustLoginId> </CustId> <ClientDt>…</ClientDt> <CustLangPref>en-US</CustLangPref> <ClientApp> <Org>ISO</Org> <Name>XML_TEST</Name> <Version>1.0</Version> </ClientApp> <ServerDt>…</ServerDt> <Language>en-US</Language> </SignonRs> <ClaimsSvcRs> <Status> <StatusCd>0</StatusCd> </Status> <RqUID>…</RqUID> <ClaimInvestigationAddRs>

<RqUID>Request Identifier for this claim returned here</RqUID>

<TransactionResponseDt>Client date returned here</TransactionResponseDt> <CurCd>US</CurCd> <MsgStatus> <MsgStatusCd>ResponsePending</MsgStatusCd> </MsgStatus> </ClaimInvestigationAddRs> </ClaimsSvcRs> </ACORD>

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XML Format Error

ISO ClaimSearch creates an XML Format Error when required aggregates, elements, id’s, or idref’s on a submitted claim are invalid, not provided, or out of order. If the XML format is not valid due to one of these reasons, an immediate Response will be returned to the member’s outgoing IPA. No claims data is sent in the Response, just a <StatusCd> and a <StatusDesc> which may or may not identify where the XML formatting is in error. Note –XML format errors will return based on the FIRST error encountered within the claim; however, there may be more than one rejection reason within a claim submission. Please review the entire claim for other possible errors before resubmitting. <ACORD> <Status> <StatusCd>300</StatusCd>

<StatusDesc> <![CDATA[ Unexpected Error: Reference to undeclared ID is 'ClaimsParty-01'. An error occurred at , (1, 4052). :: at System.Xml.XmlValidatingReader.InternalValidationCallback(Object sender, ValidationEventArgs e) at System.Xml.Schema.ForwardRef.Check(SchemaInfo sinfo, Validator validator, ValidationEventHandler eventhandler) at System.Xml.Schema.Validator.CheckForwardRefs() at System.Xml.Schema.Validator.CompleteValidation() at System.Xml.XmlValidatingReader.ReadWithCollectTextToken() at System.Xml.XmlValidatingReader.Read() at ISO.Claimsearch.XmlSubmission.XmlSubmission.Validate(String SchemaPath) at ISO.Claimsearch.XmlSubmission.XmlSubmission.Submit(String rqXmlStr, String SchemaPath, String sCallingIPAddress)

]]> </StatusDesc> </Status> </ACORD>

AgencyId Error

If a Request is submitted where the <AgencyId> is missing or the first four characters are invalid, an XML Format Error Response will be sent to the member’s outgoing IPA indicating that an MQ processing error has occurred (code 2085) as we use this information to direct your claim through our processing queues. If a Request is submitted where the first 4 characters of the <AgencyId> are valid, but the last five are not valid for XML processing, then a Response (Successful or Rejected) cannot be sent from the ISO System as we use this information to identify the member’s incoming post-back URL.

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XML Reject Response

ISO ClaimSearch creates an XML Reject Response (Data Error) when required information on a submitted claim is either invalid or not provided. XML Data Errors are returned to the member’s incoming post-back URL and will always begin with txtMatch=<ClaimInvestigationAddRs>. The Data Error will contain a <MsgStatusCd> of “Rejected” followed by a text description of the error details in the <MsgStatusDesc> (See Appendix C – Edits). The MsgStatusDesc field can display up to 5 errors per ClaimsParty, and up to 8 errors for the entire claim. It is up to the member company to correct the field within their system and resubmit the claim for processing. When correcting an initial reporting error and resubmitting the record, please ensure the claim is sent as an Initial filing. The following Rejection Key Fields are provided (with all applicable codelistref’s and idref’s) back to the member company, if provided on the initial claim submission. The purpose of these fields is to assist in the identification of the claim within the subscriber’s system. Although the fields displayed may contain the error(s) which caused the claim to reject, the full claim should be reviewed as fields outside of those shown may also contain reasons for rejection. All ids and idrefs will be ISO generated UUID’s except for the ClaimInvestigationAddRs RqUID which returns the subscriber’s ClaimInvestigationAddRq RqUID in this field. NOTE – the Id’s shown in this example are intentionally made as “human-readable” to demonstrate how <RemarkText> may be applied to a claim to aide in the identification of a claim on the Response (either Error or Match Report).

Data Element Location

MsgStatusCd ClaimInvestigationAddRs/MsgStatus = “Rejected”

MsgErrorCd ClaimInvestigationAddRs/MsgStatus = “DataError”

MsgStatusDesc ClaimInvestigationAddRs/MsgStatus (See Appendix C for full list of error codes”

Policy Number ClaimInvestigationAddRs/ Policy/ PolicyNumber

Policy Type ClaimInvestigationAddRs/ Policy/ LOBCd

Insuring Company ID ClaimInvestigationAddRs/ Policy/ MiscParty/ ItemIdInfo/ AgencyId and ClaimInvestigationAddRs/Policy/MiscParty/MiscPartyRoleCd = “CarrierInsurer”

Claim Number ClaimInvestigationAddRs/ ClaimsOccurrence/ ItemIdInfo/ InsurerId

Date of Loss ClaimInvestigationAddRs/ ClaimsOccurrence/ LossDt

Claims Party ID ClaimInvestigationAddRs/ ClaimsParty/ @id (See Remark Text)

Claims Party Name ClaimInvestigationAddRs/ ClaimsParty/ GeneralPartyInfo/ PersonName or CommlName

Claims Party Role Code ClaimInvestigationAddRs/ ClaimsParty/ ClaimsPartyInfo/ ClaimsPartyRoleCd

Casualty Loss Info ID (If Applicable) ClaimInvestigationAddRs/ ClaimsParty/ ClaimsInjuredInfo/ @id (see Remark Text)

Property Loss Info ID (If Applicable) ClaimInvestigationAddRs/ PropertyLossInfo/ @id (see Remark Text)

Auto Loss Info ID(If Applicable) ClaimInvestigationAddRs/ AutoLossInfo/ @id (see Remark Text)

Remark Text (at Claim Level) ClaimInvestigationAddRs/ RemarkText (idref=ClaimsOccurrence) – up to 20 bytes

Remark Text (at ClaimsParty Level) ClaimInvestigationAddRs/ RemarkText (idref=ClaimsParty) – up to 5 bytes

Remark Text (at Coverage Level) ClaimInvestigationAddRs/ RemarkText (idref=ClaimsInjuredInfo, PropertyLossInfo, or AutoLossInfo) – up to 20 bytes

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<ClaimInvestigationAddRs>

<RqUID>Request Identifier for this claim returned here</RqUID> <TransactionResponseDt>…</TransactionResponseDt> <CurCd>…</CurCd> <CodeListRef>…</CodeListRef> <MsgStatus> <MsgStatusCd>Rejected</MsgStatusCd> <MsgErrorCd>DataError</MsgErrorCd> <MsgStatusDesc>UO0103B – ADDRESS LINE 1 MISSING OR INVALID</MsgStatusDesc> </MsgStatus> <Policy> <PolicyNumber>…</PolicyNumber> <LOBCd>…</LOBCd> <MiscParty> <MiscPartyInfo> <ItemIdInfo>…</ItemIdInfo> <MiscPartyRoleCd>CarrierInsurer</MiscPartyRoleCd> <MiscPartyInfo> </Policy> <ClaimsOccurrence id =”id1”> <ItemIdInfo> <InsurerId>…</InsurerId> </ItemIdInfo> <LossDt>…</LossDt> </ClaimsOccurrence> <ClaimsParty id=”id2”> <GeneralPartyInfo> <NameInfo> <PersonName> <Surname>…</Surname> <GivenName>…</GivenName> </PersonName> </NameInfo> </GeneralPartyInfo> <ClaimsPartyInfo> <ClaimsPartyRoleCd>…</ClaimsPartyRoleCd> </ClaimsPartyInfo> </ClaimsInjuredInfo id=”id3”> </ClaimsParty> <ClaimsParty id=”id4”> <GeneralPartyInfo> <NameInfo> <CommlName> <CommercialName>…</CommercialName> </CommlName> </NameInfo> </GeneralPartyInfo> <ClaimsPartyInfo> <ClaimsPartyRoleCd>…</ClaimsPartyRoleCd> </ClaimsPartyInfo> </ClaimsParty> </PropertyLossInfo id=”id5”> </AutoLossInfo id=”id6”> <RemarkText idref=”id1”>…</RemarkText”> <RemarkText idref=”id2”>…</RemarkText”> <RemarkText idref=”id3”>…</RemarkText”> <RemarkText idref=”id4”>…</RemarkText”> <RemarkText idref=”id5”>…</RemarkText”> <RemarkText idref=”id6”>…</RemarkText”> </ClaimInvestigationAddRs>

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XML Success Response

Upon submission of claim to the ISO ClaimSearch system, the system searches the database and finds claims similar to the ones submitted by your organization, an asynchronous Response File is returned to the member’s incoming post-back URL provided by the subscriber with a <MsgStatusCd> of “Success.” The claims that are submitted by your company, as well as all claims in the database that appear to be related to these claims, will be returned as a “Match Report”. The System also generates negative responses (“no matching claims found”) and returns these as well, sometimes referred to as a “No Match Report”. The Match reports are logically connected through the use of the ISO FileNumber found in the ClaimInvestigationAddRs/ ClaimsOccurrence/ ItemIdInfo/ AgencyId. This number uniquely identifies each incoming claim and becomes part of the System record. Along with the Initial ISO Received Date, this field is maintained even when a Replacement or Update is submitted on a claim. An XML Success Response will always begin with txtMatch=<ClaimInvestigationAddRs>. It will include an echo of the submitted claim, as well as the matches or an indicator that there are no matches at this time. Each matching claim will be within a separate <MatchDetails> aggregate. If no <MatchDetails> aggregate is present, then no matches were found, i.e. No Match Report. NOTE

All ids and idrefs will be ISO generated UUID’s except for the ClaimInvestigationAddRs RqUID which returns the subscriber’s ClaimInvestigationAddRq RqUID in this field.

If optional data submitted on Request is not present on the Response, it either contained invalid data or id/idref/codelist/codelistref was not entered correctly and the data was dropped in processing.

For companies who do not wish to program to read the raw XML, the match reports may have a Stylesheet template applied to them so that the files may be viewed in an internet browser HTML format. (See Stylesheets section or contact ISO ClaimSearch at ClaimSearchDatabaseDevelopment@iso.com for further information.)

Summary of XML Success Response Aggregates in Schema Order

ClaimInvestigationAddRs Every XML transmission must contain at least one <ClaimInvestigationAddRs>. This aggregate

indicates the beginning and ending of the claim information. The RqUID for the ClaimInvestigationAddRq is returned on the ClaimInvestigationAddRs in order to tie

the response back to the request. In the case of a Research request (UpdateInd=4), the RqUID of the last successful initial or replacement request will be sent instead.

CodeList All ISO generated codelists used in this file are listed with UUID identifiers.

MsgStatus Element MsgStatusCd whether the Response is a Success or Reject

Policy Return Echo of the Policy Number, Policy Type, and AgencyId submitted on Request Return Echo of the Physical Risk Address, Mailing Address, and SIU Investigator Information if

submitted on Request. ClaimsOccurrence

Return Echo of the ClaimsOccurrence data submitted on Request, especially LossDt, InsurerId, and Location of Loss

Includes ISO FileNumber in ClaimsOccurrence/ItemIdInfo/AgencyId and ISO Received Date in ClaimsOccurrence/com.iso_ReceiveDt.

ClaimsParty Return Echo of the ClaimsParty information as submitted on Request. This can be repeated to include

all involved parties, service providers, alias information, or additional claimants as submitted on request.

For auto theft claims, ClaimsParty information for Recovering Agency as submitted on Request by Insurer, or as provided by police agencies or National Insurance Crime Bureau (NICB).

For auto, boat, or mobile equipment salvage, ClaimsParty information for third party salvage buyer with role code “SalvageBuyer”.

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ClaimsInjuredInfo

Return Echo of the ClaimsInjuredInfo information as submitted on Request.

May repeat for multiple casualty losses. PartyInvestigationInfo

Includes SSN and TIN validation as well as Statement of Dispute information. com.iso_AppendDS

Please see the Additional Optional Service – Append-DS for further information.

Returned within the ClaimsParty of the claimant searched against Public Records.

May be repeated up to 10 times, depending on the data found. ClaimsPartyRelationship

Return Echo of the ClaimsPartyRelationship aggregates that tie together involved parties and their associated service providers, aliases, and additional claimants.

This is not used to tie Recovering Agency or SalvageBuyer to an involved party. AdjusterParty

Return Echo of the AdjusterParty contact information as submitted on the Request. May repeat for multiple adjusters AdjusterPartyInfo

Return Echo of the AdjusterPartyInfo as submitted on the Request

May refer to a ClaimsInjuredInfo id, PropertyLossInfo id, or AutoLossInfo Id AutoLossInfo

Return Echo of the AutoLossInfo as submitted on Request. PropertyLossInfo

PropertySchedule

Return Echo of the PropertySchedule as submitted on Request

If IsSummaryInd was submitted as 1 or 0, it will return as X on Response ItemInfo

Return Echo of the PropertyLossInfo/ItemInfo as submitted on Request

Return Echo of the PropertyLossInfo/ClaimsSubjectInsuranceInfo as submitted on Request Watercraft

Return Echo of the PropertyLossInfo/Watercraft as submitted on Request ClaimsSubjectInsuranceInfo

ClaimsSubjectInsuranceInfo may repeat for individual SubjectInsuranceCd values.

ClaimsPayment

Return Echo for the General Property coverage (Building, Contents, Stock, Loss of Use, or Other) and the dollar amounts for Policy Amount, Reserve, Estimated Loss, or Payment Amount.

WorkCompLossInfo Return Echo of the WorkCompLossInfo as submitted on the Request May only refer to ClaimsInjuredInfo

ClaimsPayment Return Echo to identify the dollar amounts for Policy Amount, Reserve, Estimated Loss, or Payment

Amount as well as the Claim Status (ex. open, closed, closed without payment, etc). This aggregate is used in for reporting the dollar amounts associated with ClaimsInjuredInfo,

AutoLossInfo, PropertyLossInfo/ItemInfo, and PropertyLossInfo/Watercraft. Please see Appendix E – Claims Payment and Status Reporting Rules for further information.

RemarkText Return Echo of RemarkText as submitted on the Request Uses ItemRef for Vehicle Theft Verification text from NCIC police data (up to 237 characters) Uses idref for all other references (5 characters in reference to ClaimsParty, 20 characters for all other

references) InvestigationInfo

Return Echo of InvestigationInfo elements, includes VIN Validation Information. RecoveryInfo

Includes Theft Recovery information (as provided by Ins. Company, police agencies, or NICB).

May refer to a PropertyLossInfo id or AutoLossInfo id.

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com.iso_TheftVerification

Provides information on whether the Vehicle Theft has been reported to a police agency and entered into the NCIC system.

SalvageInfo

Return Echo of the vehicle, boat, or mobile equipment SalvageInfo as submitted on the Request com.iso_VehRecall

Please refer to Additional Services – NHTSA Recall for further information.

Refers to the AutoLossInfo of the claimant searched

May be repeated up to 10 times, if more than one recall is found.

If com.iso_RecallRqInd is 1, this record will be returned even if no recall information is found. In that case, the Vehicle Year, Make, Model and Summary fields will be the only fields populated.

InvestigationInfo/ AutoInvestigationInfo

Shipping information - Received from Vehicle Manufacturers when vehicles are shipped from assembly plants.

This information will only be received by customers who are members of both ISO ClaimSearch and the National Insurance Crime Bureau (NICB).

Data elements will include: AutoInvestigationInfo with EventCd=”Shipping”, Shipping Date, and Shipped Condition Description; and AutoLossInfo with VIN, Year, Make, and Model.

RecoveryInfo Additional Theft Recovery and/or Impound information as reported by police agencies or National

Insurance Crime Bureau (NICB), includes CannedRecoveryCd, RecoveryLocDesc, com.iso_RecoveryVehNumber (all for impounded vehicles), and com.iso_VehRecoveryInd.

com.iso_AddCovInfo com.iso_CovInfo1

Return Echo of the com.iso_CovInfo1 as submitted on the Request

May refer to a ClaimsInjuredInfo id or an AutoLossInfo id

May be repeated for each com.iso_CovInfo1 submitted on Request com.iso_CovInfo2

Return Echo of the com.iso_CovInfo2 as submitted on the Request

May refer to a ClaimsInjuredInfo id or an AutoLossInfo id

May be repeated for each com.iso_CovInfo2 submitted on Request com.iso_CMS

Warning regarding fields missing for CMS reporting. The presence of this aggregate does not stop the claim from being sent to CMS at the next schedule Quarterly Reporting period.

Only provided on searchable involved parties marked as Medicare Eligible. If a claim is marked with the <SuppressMatchInd>, no warning will be sent. Likewise, for Update Records which don’t perform searches (UpdateInd=1, 2, 3, 5 & 6), no Warnings will be provided.

MatchReportTypeCd Provides the Return Reason Code = I - Initial; P – Replacement; Q – Impound Update; R – Research;

S – Automatic Update; V – Recovery. com.iso_ClaimDirectorInd

Returned only if the com.iso_ClaimDirectorInd was populated with “1,” and your company has signed up for the ClaimDirector Optional Service.

com.iso_ClaimsScoringInfo Please see the Additional Optional Service – ClaimDirector for further information. Returned only if the com.iso_ClaimDirectorInd was populated with “1” and your company has signed

up for ClaimDirector This aggregate contains information regarding the actual scoring of the claim, such as the Score itself

and the number of times scored. com.iso_ClaimsHandlingCharacteristics

May repeat if more than one claim handling characteristic was found for a claim. com.iso_ClaimDirectorRules

May repeat if more than one claim handling rule was found for a claim.

If rule applies to the entire claim, idref will refer to ClaimsOccurrence.

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If the rule applies to the involved party, idref will refer to ClaimsParty. com.iso_ClaimsScoreReport

This aggregate will not always be present.

Provide the details of the first 15 matches which were included in the score. If more than 15 matches, this record will be repeated with up to an additional 10 matches. The highest scores are sent first.

com.iso_RecallRqInd Return Echo of the com.iso_RecallRqInd if submitted on Request

com.iso_SIUParty Return Echo of the com.iso_SIUParty submitted on Request, includes SIU investigation elements and

CMS required fields. May be associated with an involved party or service provider. May be repeated for each com.iso_SIUParty submitted on Request Will alternate with LitigationInfo for each party both are submitted on.

LitigationInfo Return Echo of the LitigationInfo as submitted on the Request May only refer to ClaimsInjuredInfo

MatchInfo/AdditionalMatchInfo This aggregate provides information on additional matches to the submitted data. For example, a claim

is submitted to ISO ClaimSearch (Claim 1). Data in Claim 1 (for example, the claimant’s SSN) matches data in another claim (Claim 2). Other data in Claim 2 also matches other claims in the system. This aggregate provides notification that there are other claims that match Claim 2 in the system, the type of data matched on, and the value that was matched on.

On the stylesheet reports, this is displayed with a statement following the Claim 2 data of “more matches found outside this report.”

MatchDetails Matching Insurance Claims - Same aggregates and subaggregates as return echo aggregates in this

order, exceptions are in bold: Policy (includes Company contact information in place of AgencyId), ClaimsOccurrence (includes ISO FileNumber of matching claim), ClaimsParty, ClaimsInjuredInfo, ClaimsPartyRelationship, AdjusterParty, AdjusterPartyInfo, AutoLossInfo, PropertyLossInfo, WorkCompLossInfo, ClaimsPayment, MatchReasonInfo, com.iso_SumReasonInfo, LitigationInfo, and InvestigationInfo

MatchReasonInfo

This aggregate contains information associating a ClaimsParty with the reason for match.

com.iso_SumReasonInfo

This aggregate includes the ISO FileNumber of up to 25 Matching Reports and up to five 2 byte codes identifying the reason for match for each ISO FileNumber

AppraiserActivityInfo

Provides Estimate, Appraisal, and/or Valuation information as provided by auto physical damage estimating information providers under its own MatchDetails aggregate.

Data elements will include: ISO FileNumber; Policy Type (Will use the MarketTypeCd codelist for LOBCd), Insurance Company Name; AppraiserActivityInfo with Activity Type (Estimate, Appraisal, or Valuation) and Activity Date; AdjusterPartyInfo with Coverage Code; and AutoLossInfo with VIN and Impact Point Code.

Other data elements which are optional: Policy Number, Claim Number, Vehicle Year, Make, Model License Plate/State, Odometer Reading, Claim Amount, Insured Name.

Match Data through NICB Membership

There are specific types of matches that can be received on VIN searches, if the ClaimSearch member also has a membership with National Insurance Crime Bureau (NICB). These MatchDetails aggregates contain additional VIN history information, including Export and Impound as outlined below. It also includes additional theft recovery as reported by police agencies or NICB, and Shipping and Assembly information which are both returned within the echo information above (see InvestigationInfo/ RecoveryInfo and InvestigationInfo/ AutoInvestigationInfo above)

Each will be returned within their own MatchDetails aggregate.

Each type of VIN history match will produce a different set of data elements. The lists below state

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which elements are specific to that type of Response.

Export information

Supplied by US Ports regarding vehicles leaving the country.

Data elements will include an ISO FileNumber; ClaimsParty with Export Port Name in the CommercialName field; AutoInvestigationInfo with EventCd=”Export”, Export Date, and Delivery Destination; and AutoLossInfo with VIN, Year, Make, and Model.

Vehicle Impound information

Submitted by police agencies which will generate the Impound Automatic Update. This will be returned with MatchReportTypeCd “Q” and an echo back of the initiating claim.

Data elements will include an ISO FileNumber; ClaimsParty with Role code “ImpoundFac” which only includes the CommercialName and PhoneNumber of the Impound Location, and a ClaimsParty with role code “ImpouundAgcy” which only includes the CommercialName and Phone Number of the Impounding Agency; AutoInvestigationInfo with EventCd=”Impound”, Impound Date, Police Report Case Number, and Additional Impound Information; and AutoLossInfo with VIN, VIN Validation, Year, Make, Model, License Plate, and License Plate State. May also include 30 characters of Miscellaneous Text in a RemarkText field.

com.iso_SIUParty Return com.iso_SIUParty submitted on matching claim for SIU investigation elements only. CMS fields are not returned on matching claims. May be associated with an involved party or service provider. May be repeated for each com.iso_SIUParty submitted on a single Match Will follow directly after the MatchDetails aggregate that it corresponds to May be followed by other MatchDetails aggregates

com.iso_KeyReasonInfo Key Indicators for each involved party or service provider searched in the claim. Refers to individual ClaimsParty id.

<ClaimInvestigationAddRs>

<RqUID>Request Identifier for this claim returned here</RqUID>

<TransactionRequestDt>…</TransactionRequestDt>

<CurCd>…</CurCd>

<CodeList>……. </CodeList>

<MsgStatus>

<MsgStatusCd> Success </MsgStatusCd>

</MsgStatus>

<Policy>……</Policy>

<ClaimsOccurrence>……</ClaimsOccurrence>

<ClaimsParty>…</ClaimsParty

<AdjusterParty>…</AdjusterParty>

<AutoLossInfo>…</AutoLossInfo>

<PropertyLossInfo>…</PropertyLossInfo>

<RemarkText>..... </RemarkText>

<InvestigationInfo>..... </ InvestigationInfo >

<com.iso_AddCovInfo>…</com.iso_AddCovInfo>

<MatchReportTypeCd>..... </MatchReportTypeCd>

<MatchInfo> … </MatchInfo>

<MatchDetails>

<Policy>……</Policy>

… …

</MatchDetails>

<MatchDetails> … </MatchDetails>

<MatchDetails> … </MatchDetails>

….

</ClaimInvestigationAddRs>

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Automatic Update Reports

Match Reports are reports generated by the member’s activity within the ISO ClaimSearch system either by entering a new claim or updating an existing one. Automatic Update Reports are generated by the system when claim activity on the system by another organization matches against a claim that you previously submitted. This can be due to another organization entering a new claim, updating a previous claim within the system, or submitting additional vehicle information based on the VIN. These can be received at any time; therefore your system should be ready to receive XML messages even when your company is not submitting requests. Automatic Updates include your company’s initial claim and only the claim that generated the report. These reports can be recognized by an “S” in the return reason code <MatchReportTypeCd>. This will occur for the following specified time frames after initial reporting of a claim: Casualty – 1 Year Property – 60 Days Vehicle – 30 Days Automatic Update timeframes are based on the ISO Received Date <com.iso_ISOReceivedDt> of the INITIAL filing. Any Updates or Replacements of the initial claim filing continue to use the original date received of the initial claim. Updates and replacements do not restart the Automatic Update period. If your company is sending the <ClaimStatusCd> on each <ClaimsInjuredInfo>, <PropertyLossInfo>, or <AutoLossInfo> ClaimsPayment aggregate your company as a whole may choose to opt out of receiving Automatic Updates on Closed claims. Please have a home office representative of the member company contact info.claimsearch@iso.com for further information on this option. Vehicle Recovery Reports

ISO ClaimSearch automatically generates a Vehicle Recovery Report when a vehicle theft claim submitted to the database by a member matches with a theft recovery notice submitted to the database by the National Crime Information Center (NCIC) system used by police agencies. These records may be received at any time after the submission of a total theft claim by the member. If the NCIC information is on our database at the time of the submission of the vehicle theft claim, the recovery report will come back at the same time as the matching claim information. If the submission of the vehicle theft claim by the member enters the database first, a recovery report may be received at any time on this claim regardless of the status of the claim. When returned matches result from a “Vehicle Recovery Report,” it will appear the same as the Match Reports above, except the return reason code is “V” in the <MatchReportTypeCd> and only the initial claim and the new recovery information will be included in the file. If the claim contains multiple vehicles reported for a single ClaimsParty, the <com.iso_VehRecoveryInd> will be returned with a value of “Y” as part of the <AutoLossInfo> whose VIN matches the new RecoveryInfo. For companies that use the Stylesheets, the words “New Recovery” will appear in red next to the Vehicle Information section of the recovered vehicle. A vehicle recovery should be echoed back to ISO each time a replacement record is submitted. (Update records do not provide an echo back.) The vehicle’s condition at the time of recovery is an updateable field, and if known, should be reported and then included in replacement or update submissions. Classification is an updatable field, and if your company has authorized ISO to report theft/recovery information to NHTSA, then this field should also be reported in all submissions. If a recovery is received with a <CannedRecoveryCd> of 2 (and the <RecoveryInfo> aggregate is outside the <InvestigationInfo>), then the recovery information listed within that <RecoveryInfo> can be completely updated. This is the only type of recovery, other than an insurer recovery, that permits all fields to be updated. The <CannedRecoveryCd> of 2 also allows a company to reinstate their vehicle to an active theft in ISO, when the recovery information is not echoed back.

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If the company reinstates their claim as an active theft in ISO, it’s the responsibility of the company to contact the appropriate police agency to have the vehicle reinstated as an active theft in NCIC. If updates are necessary to the other types of recoveries, beyond condition and classification, the company should contact ISO Customer Support. Impound Update Reports

ISO ClaimSearch automatically generates an Impound Update Report when a vehicle theft claim has received a Vehicle Recovery Report (see above) and further information has been received that the vehicle has been impounded. This information is received from states participating in the NICB Impound Program. These records may be received at any time after the submission of a total theft claim by the member and recovery by a police agency. The Vehicle Recovery Report will always return first with the return reason code “V” in the <MatchReportTypeCd>. When returned matches result from an “Impound Update Report,” it will appear the same as the Match Reports above, except the return reason code is “Q” in the <MatchReportTypeCd> and only the initial claim and the new impound information will be included in the file. For companies that use the Stylesheets, the words “Impound Update” will appear in the header information of the report. VIN Quality Control

Due to the importance of finding a stolen vehicle as quickly as possible, ISO makes every attempt to correct an invalid VIN submitted with a coverage type of Comprehensive (COMP) and loss type of Theft (THFT) on the <AdjusterPartyInfo> aggregate. When a vehicle theft comes into the system, it goes up against the VIN editing tables which consist of vehicle manufacturers' shipping & assembly information to determine if the VIN passes or fails.

InvestigationInfo/ ValidVINInd will indicate if the VIN has passed (P) or failed (F).

If the VIN is valid (passed), then it is echoed back in the AutoLossInfo/ VehInfo/ VehIdentificationNumber, and the Response will be generated right away.

If the VIN fails the edit, the record is sent to the ISO Quality Control unit (QC). The record is automatically added to the ISO database, but the Response will be delayed until the VIN has been reviewed and released by QC.

If the VIN failed but was corrected by QC, then the corrected VIN is in AutoLossInfo/ VehInfo/ VehIdentificationNumber, and the failed VIN is in InvestigationInfo/ FailedVIN. The corrected VIN is searched in the ISO database and any matches are returned to the customer. Note – Both VINs are provided so that the VIN may be corrected in your system. Vehicles with invalid VINs will not be sent to NMVTIS.

If the VIN is invalid (failed) and is not correctable, then it is released from QC without changes and searched by the original VIN submitted (AutoLossInfo/ VehInfo/ VehIdentificationNumber,) and any matching information returned to the customer.

Vehicle theft VINs are corrected on a daily basis during normal business hours. A match report is generally returned within 1 business day of the date received.

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Stylesheets

A Stylesheet is used with a web browser to provide a visual representation of an XML file. By applying a Stylesheet, users will be able to view a Response as an HTML page. The Stylesheet may be used as provided for an end solution or may be used as a basis to be customized by the member. ALL COMPONENTS of a Stylesheet, included but not limited to – formatting, data elements present, order of data elements, etc, may be customized. ISO offers a Stylesheet to ISO ClaimSearch members to assist them in programming for the returns of ISO ClaimSearch in XML. Members using the Stylesheet will continue to receive the raw XML file on each claim and use additional supporting files to “apply” the Stylesheet template to view the data. To apply the Stylesheet, the following files found within the XML Customer Package.zip must be saved into the same file directory within the member’s system:

ClaimSearchCodeList.xml Display_Initial_Records.xsl cshead.gif Display_Match_Records.xsl csheadlines.gif HelperFunctions.xsl CS_XML_Output.xsl

NOTE – Within the CS_XML_Output.xsl file, there is a reference to “ISO_CS_XML.css”. This does not exist as a separate stylesheet file, but it is a dummy reference file created in the application of the stylesheet files. The member will receive a raw XML file on their incoming post-back URL. This file should be saved to the same directory as the files above. The following XML “Stylesheet” statement should be inserted into the raw XML file as the first element of the file, so that it appears as such: <?xml-Stylesheet type="text/xsl" href=".\CS_Xml_Output.xsl"?> <ClaimInvestigationAddRs> When the raw XML is saved with this statement added, the next time the file is opened, it should open in your system’s internet browser appearing as an HTML file. Programs are available on the public internet that will allow for the conversion of the HTML file to a PDF file for easier storage and display within the member’s claim system. NOTE - New Stylesheet files are generally released more frequently than user manuals in order to keep our members up to date with the latest enhancements and corrections in our output formats. It is advised to implement the Stylesheet files in such a way as to make it easy to replace the existing files with minimal testing and change management processing. Any customizations, including those made to read the file properly for your programming language, will need to be recreated each time new Stylesheet files are applied within your system.

Disclaimer Notice

When creating match reports or displaying match reports within your claim system, your company may want to add the following notice or a similar disclaimer notice to the match report: Reasonable procedures have been adopted to maximize the accuracy of this report. Independent investigations should be performed to evaluate the relevant data provided.

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ENTITIES

In all following tables, “Length” refers to the length of the field for ISO ClaimSearch processing purposes. ACORD Document Request Entity (%ACORDREQ)

A request document must contain at least a Signon request.

Tag Type Usage Length Description

<SignonRq> Aggregate Required

<ClaimsSvcRq> Aggregate Required ACORD lists this as a repeating aggregate; ISO will only recognize the first one reported on the transaction. Multiple claims in a single transaction should be repeated at the <ClaimInvestigationAddRq> level.

Claims Investigation Information Entity (%CLAIMSINVESTIGATIONINFO)

This entity contains the basic information required for claims investigation messages.

Tag Type Usage Length Description

<Policy> %PCPOLICY Required

<ClaimsOccurrence> Aggregate Required

<ClaimsParty> Aggregate Required

Repeating

ISO requires at least one insured to be reported on property claims, and one insured and one claimant or one claimant/insured to be reported on casualty or auto claims.

<ClaimsPartyRelationship> Aggregate Optional Repeating

Required for Service Provider and AKA Information

<com.iso_SIUParty> Aggregate Optional To report investigation details for an involved party and/or service provider.

<AdjusterParty> Aggregate Required Repeating

<AutoLossInfo> Aggregate Optional Repeating

ISO requires at least one LossInfo aggregate (Auto, Property, or ClaimsInjured) to be reported on each claim.

<PropertyLossInfo> Aggregate Optional Repeating with limitations

PropertyLossInfo may be reported multiple times per claim with limitations (see aggregate for details). ISO requires at least one LossInfo aggregate (Auto, Property, or ClaimsInjured) to be reported on each claim.

<WorkCompLossInfo> Aggregate Optional Repeating

<LitigationInfo> Aggregate Optional Repeating

To report litigation information associated with a ClaimsInjuredInfo

<ClaimsPayment> Aggregate Optional Repeating

Note - Estimated Loss Amount is required for reporting Property Fire claims to State Fire Marshal Offices.

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Tag Type Usage Length Description

<RemarkText> ItemRef when referencing <RecoveryInfo>

idref when referencing any other aggregate

Optional Repeating

C-20 for request C-237 for response

When used on a request, ISO will only accept a max length of 20 characters. (Note: when referring to a ClaimsParty, the size is further restricted to just 5 characters). When used on a response, ISO may populate this element with data up to 237 characters.

This field requires an idref that references the aggregate to which it applies It may be repeated for multiple aggregates.

Claims Message Request Information Entity (%CLAIMSMSGRQINFO)

This entity contains the basic information required for all REQUEST messages.

Tag Type Usage Length Description

<RqUID> UUID_NoID Required Request Identifier. Sent by a client as a universally unique identifier for the message. Used to correlate responses with requests.

<TransactionRequestDt> DateTime Required The date/time the request was created. This is the client date. YYYY-MM-DDTHH:MM:SS

<CurCd> Open Code List Required Currency Code. Value=”USD” for ISO ClaimSearch US members.

<CodeList> Aggregate Required Repeating

ISO-defined code lists are required on every claim submitted. See Appendix A for full listing. Do not submit for code lists marked as ACORD.

Claims Message Response Information Entity (%CLAIMSMSGRSINFO)

This entity contains the basic information required for all RESPONSE messages.

Tag Type Usage Length Description

<com.iso_CustLoginId> Element Extension

Optional Login ID sent from ISO to member on the response to aid member in validating message string for security purposes. ID is provided by member.

<com.iso_CustLoginPwd> Element Extension

Optional Login Password sent from ISO to member on the response to aid member in validating message string for security purposes. Password is provided by member.

<com.iso_CustDomain> Element Extension

Optional Login Domain sent from ISO to member on the response to aid member in validating message string for security purposes. Domain is provided by member.

<RqUID> UUID_NoID Required

Echo

Request Identifier. Sent by a client as a universally unique identifier for the message. Used to correlate responses with requests.

<TransactionResponseDt> DateTime Required The date/time the request was created. This is the client date. YYYY-MM-DDTHH:MM:SS

<CurCd> Open Code List Optional

Echo

Currency Code. Value=”USD” for ISO ClaimSearch US members.

<CodeList> Aggregate Optional

Repeating

<MsgStatus> Aggregate Required

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Currency (%Currency)

The currency base class is used for all currencies within this business specification.

Tag Type Usage Length Description

<Amt> Decimal Required C-11 The amount of money. Must be reported in whole dollars for ISO ClaimSearch. May be reported with dollars and cents for CMS Reporting on the <cov.iso_CovInfo1> only.

Duration (%DURATION)

This base class captures either a generic or specific time period. It can be as generic as 15 days or as specific as a start and end date.

Tag Type Usage Length Description

<EffectiveDt> Date Optional C-10 This is an effective date, the explicit meaning of which is implied by its parent or its usage. YYYY-MM-DD

<ExpirationDt> Date Optional C-10 This is an expiration or termination date, the explicit meaning of which is implied by its parent or its usage. YYYY-MM-DD

<DurationPeriod> %MEASUREMENT

Optional C-5 The length of time spanning from start date to end date.

Measurement (%MEASUREMENT)

This base class is used to capture both a measurement and the unit of measurement for all tags with this data type. For instance, <OdometerReading> would use this to show that the vehicle traveled 10,000 miles.

Tag Type Usage Length Description

<NumUnits> Decimal Required C-Varies

The number of units, the meaning of which is implied by its usage. ISO USES WHOLE NUMBERS ONLY; LENGTH OF FIELD DEPENDS ON USAGE.

Property Casualty Policy Entity (%PCPOLICY)

The PCPOLICY entity is a super-entity holding all of the policy related aggregates. Currently this entity is intended to be used for Personal and Commercial Lines.

Tag Type Usage Length Description

<PolicyNumber> C-25 Required C-30 The unique number assigned to the policy, or submission, being referenced. ISO ALLOWS THIS ELEMENT TO BE 30 CHARS

<LOBCd> Code List Required C-4 A code identifying the line of business. This element uses the PolicyTypeCd code list. Please refer to Appendix A and B. On Response, can also refer to MarketTypeCd code list for Appraisal Policy Type.

<ContractTerm> %DURATION Optional This indicates the period for the contract, policy, binder, etc.

<MiscParty> Aggregate Required This aggregate contains the ISO assigned Insurer Reporting Code, Physical Risk Address, Mailing Risk Address, SIU Contact Information, and NMVTIS Operator Entity ID

<AssignedRiskInd> Boolean Optional C-1 Indicates if this policy is written under the assigned risk plan.

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WRAPPER AGGREGATES

In all following tables, “Length” refers to the length of the field for ISO ClaimSearch processing purposes. ACORD Aggregate <ACORD>

An ACORD Document is a collection of services and messages sent as a single unit between client and server.

Tag Type Usage Length Description

(%ACORDREQ) Entity Required A request document must contain at least a Signon request.

Signon Aggregates

Client Application Aggregate <ClientApp> The primary use of the <ClientApp> aggregate is to inform a member service representative about what software was used to create or change an object. <ClientApp> conveys the application that is acting as the client endpoint of the ACORD message.

Tag Type Usage Length Description

<Org> Assigned Identifier_NoIDoID

Required Organization. Value=”ISO” for ISO ClaimSearch US members.

<Name> C-40_NoID Required Client Application Name. Value=”XML_TEST” for ISO ClaimSearch US members.

<Version> NC-12_NoID Required Client Application Version. Value=”1.0” for ISO ClaimSearch US members.

Member Identification Aggregate <CustId> The <CustId> aggregate is used to uniquely identify the member who submits a request.

Tag Type Usage Length Description

<SPName> Assigned Identifier

Required Service Provider name. Value=”iso.com” for ISO ClaimSearch US members.

<CustLoginId> Assigned Identifier_NoIDoID

Required C-5 Member Login ID – ISO assigns a unique ID to each member. It is a 5 character code beginning with “X”

Member Password Aggregate <CustPswd>

Tag Type Usage Length Description

<EncryptionTypeCd> Code List Required Encryption Type. Value=”NONE” for ISO ClaimSearch US members.

<Pswd> C-32_NoID Required C-8 Clear text Password. ISO assigns a default password that is non-expiring for XML submissions. The password will be encrypted by the SSL used in the transmission process

Signon Password <SignonPswd>

Tag Type Usage Length Description

<CustId> Aggregate Required

<CustPswd> Aggregate Required

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Signon Request <SignonRq>

Tag Type Usage Length Description

<SignonPswd> Aggregate Required Contains ISO ClaimSearch assigned ID and Password

<ClientDt> DateTime_NoID

Required Client DateTime. Time according to the client. YYYY-MM-DDTHH:MM:SS

<CustLangPref> NC-11_NoID

Required Value=”en-US” for ISO ClaimSearch US members.

<ClientApp> Aggregate Required

Claims Service

Request <ClaimsSvcRq>

ACORD allows this aggregate to repeat. ISO only accepts the first instance. All ids submitted within this aggregate must be unique across the entire transmission. The User Id and Password submitted must be valid for EACH AgencyId submitted within the <ClaimSvcRq> in order to pass the security check.

Tag Type Usage Length Description

<RqUID> UUID_NoID Required Request Identifier. Sent by a client as a universally unique identifier for the message. Used to correlate responses with requests.

<ClaimInvestigationAddRq> Aggregate Required Repeating

This may be repeated to submit multiple claims in a single transmission; however ISO will split the claims at this level and process individually.

Claims Investigation Submission Messages

Request <ClaimInvestigationAddRq>

This level represents the beginning of a single claim. Although ISO will accept multiple claims submitted within a single ClaimsSvcRq, we will separate the claims at the ClaimInvestigationAddRq level and process individually, providing individual Error or Response files.

Tag Type Usage Length Description

(%CLAIMSMSGRQINFO) Entity Required This entity contains the basic information required for all claims request messages.

<ReplacementInd> Boolean Optional C-1 1=Indicates whether the information being submitted is intended to completely replace, not update, the existing information. ISO will find the initial claim, remove it from the database and replace with the claim that is submitted in this request. It is vital that the entire claim be contained within this request and not just tags that have changed since the last submission.

<SuppressMatchInd> Boolean Optional C-1 1=Indicates that the submitter only wants the data added to the database. No search will be completed; no Response will be generated, unless the claim is rejected. CMS Warning Codes can only be provided as part of the search and Response processes.

<SearchBasisCd> Code List Optional A code identifying the basis for the search. This element uses the SearchBasisCd code list. (I = Individual; C = Entire Claim) Required for Research requests.

(%CLAIMSINVESTIGATIONINFO)

Entity Required

<InvestigationInfo> Aggregate Optional Repeating

Required for NMVTIS reporting

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Request <ClaimInvestigationAddRq> (cont.)

Tag Type Usage Length Description

<com.iso_AddCovInfo> Aggregate Optional Required for CMS Medicare reporting

<com.iso_ClaimDirectorInd> Boolean Extension

Optional C-1 1=submit ClaimDirector claim & receive score. (This is an optional service that companies may choose to add to their basic service. Populating this field means you will receive the ClaimDirector aggregates returned in the response.)

<com.iso_ConvertLegacyToUFInd>

Boolean Extension

Optional Request Only

C-1 1=convert the legacy claim to UF. This only applies to Casualty and Property claims – not Auto. See “Transitioning from Legacy System Reporting” for more information.

<com.iso_RecallRqInd> Boolean Extension

Optional C-1 Y=Request NHTSA Vehicle Recall Information. (This is an optional service that companies may choose to add to their basic service. Populating this field means you will receive the com.iso_VehRecall aggregate(s) returned in the response.)

Response <ClaimInvestigationAddRs>

The response to the investigation submission is often referred to as a Match Report. The Match Report begins at the ClaimInvestigationAddRs level and will only return one ClaimInvestigationAddRs in each Response. Update Requests using UpdateInds 1, 2, 3, 5, or 6 do not generate a Response, nor do Requests with the <SuppressMatchInd> set to “1” on the ClaimsOccurrence. These Requests will only receive the ClaimInvestigationAddRs if there is an XML Data Error.

Tag Type Usage Length Description

(%CLAIMSMSGRSINFO) Entity Required This entity contains the basic information required for all claims response messages.

(%CLAIMSINVESTIGATIONINFO) Entity Required This is an echo back of the member’s initial claim information as it is stored on the ISO system.

<InvestigationInfo> Aggregate Optional Repeating

This may contain both echo back of the member’s initial claim information as well as additional Vehicle Shipping and Theft Recovery information.

<com.iso_AddCovInfo> Aggregate Optional This contains Additional Coverage Info for CMS and Mass Tort Reporting.

<MatchReportTypeCd> Code List Required This element uses the MatchReportTypeCd code list.

<com.iso_WebOverlayInd> Element Optional

Response Only

C-1 Y = This claim has been touched on the ISO website. Information echoed back from the system may be different than what was sent. This element does NOT appear in the stylesheets and is intended as a system flag.

<com.iso_ClaimDirectorInd> Boolean Extension

Optional C-1 1=ClaimDirector claim sent & score returned

<com.iso_ClaimsScoringInfo> Aggregate Extension

Optional

<MatchInfo> Aggregate Optional

<MatchDetails> Aggregate Required Repeating

This is a report of the matching claim information as submitted by another member company or ISO associated organization.

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Miscellaneous Aggregates

Code List Aggregate <CodeList> When needed, this aggregate contains the additional information pertaining to a specific open or closed Code List contained within a data stream. ISO ClaimSearch requires the use of Code Lists within each file to identify Universal Format specific codes. Please refer to Appendix A for a full listing of all ISO ClaimSearch Code Lists.

Tag Type Usage Length Description

@id Identifier Type

Required This attribute is an identifier to a specific element.

<CodeListName> C-255 Required This is a text string describing the code list being used.

<CodeListOwnerCd> Code List Required This is the owner of the code list being referenced, for instance: ACORD, NCCI, or WISe. Value=”ISOUS” for ISO ClaimSearch US members.

Message Status Aggregate <MsgStatus> This aggregate is used in a Response message to provide the complete status from the result of processing the matching request.

Tag Type Usage Length Description

<MsgStatusCd> Code List Required The values returned are listed in the MsgStatusCd code list in the Appendix A

<MsgErrorCd> Code List Optional - see description

Required when <MsgStatusCd> is Rejected. This provides the overall error code for the message. This element uses the MsgErrorCd code list in Appendix C.

<MsgStatusDesc> C-Infinite Optional Message status description. This is only sent when <MsgStatusCd> is Rejected. The values are listed in Appendix C.

Status Aggregate <Status>

Tag Type Usage Length Description

<StatusCd> Code List Required Framework Response Status Code. Valid values depend on context. See the ACORD standards for a list of the values and their context.

<StatusDesc> C-255_NoID

Optional Status Description. (Success or Failure)

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AGGREGATES

All aggregates are listed in alphabetical order and may be used within multiple locations within a single claim transmission. In all following tables, “Length” refers to the length of the field for ISO ClaimSearch Basic Service maximum length of field. Characters submitted over this length will be dropped in the processing. Additional Information <com.iso_AddInfo>

This aggregate contains additional claim level information.

Tag Type Usage Length Description

<com.iso_EntityId> Assigned Identifier

Optional C-7 NMVTIS Operators Reporting Entity ID.

Assigned by ISO/NMVTIS. The Operator ID used for NMVTIS reporting. Only required to be entered by TPAs reporting under their TPA reporting code in order to identify which insurer the claim is being reported for.

Additional Coverage Information <com.iso_AddCovInfo>

This aggregate is optional for ISO ClaimSearch reporting, but contains fields required for CMS Medicare Reporting.

Tag Type Usage Length Description

<com.iso_CovInfo1> Aggregate Optional Repeating

Required for CMS Reporting

<com.iso_CovInfo2> Aggregate Optional Repeating

For CMS Reporting – contains optional CMS fields

<com.iso_CMS> Aggregate Optional Repeating Response Only

Only displayed if CMS Warning message is present.

Additional Matches Aggregate <AdditionalMatchInfo>

This aggregate provides information on additional matches to the submitted data. For example, a claim is submitted to ISO ClaimSearch (Claim 1). Data in Claim 1 (for example, the claimant’s SSN) matches data in another claim (Claim 2). Other data in Claim 2 also matches other claims in the system. This aggregate provides notification that there are other claims that match Claim 2 in the system, the type of data matched on, and the value that was matched on. On the website, this is displayed with a statement following the Claim 2 data of “more matches found outside this report.”

Tag Type Usage Length Description

@idref Identifier Reference

Required This attribute is an identifier reference to claims data on which the match was made.

<MatchTypeCd> Code List Required This code list identifies the data elements upon which additional matches are found. This element uses the AdditionalMatchCd code list. Please refer to the Appendix A. Example: SSN = match on social security number.

<MatchData> Element Optional C-255 Contains the value which resulted in a match. Example: If the match is SSN, this tag would contain the SSN number.

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Address Aggregate <Addr>

The Address Aggregate is used wherever a postal address, including any portion of such address, is needed. The REQUIRED fields listed below are for addresses associated with ClaimsPartyInfo. Addresses used elsewhere in the claim may require fewer fields. Please refer to the Required Elements section for further details. Note – for addresses located outside the United States, completing the CountryCd will fulfill the StateProvCd requirement – except for Canadian addresses where both elements are required.

Tag Type Usage Length Description

<AddrTypeCd> Code List Optional

Repeating

Identifies the type of address in the Policy/MiscParty/GeneralPartyInfo to distinguish between Mailing and Physical Risk Addresses. Not used in other Address aggregates. Please refer to the Appendix A – AddressType code list.

<Addr1> Element Required C-50 Address Line 1.

<Addr2> Element Optional C-50 Address Line 2.

<City> Element Required C-25 City.

<StateProvCd> Code List Required C-2 State code. Specific meaning is derived from the usage. The source of the code list is the U.S. Postal Service.

<PostalCode> Element Optional C-9 Postal Code.

<CountryCd> Code List Optional C-3 Country. ISO Standard 3166 (International Standards Organization).

<com.iso_VerifiedAddrInd> Element Extension

Optional – Response Only

C-3 Yes – This address was verified. No – This address was not verified. This field is only returned if the company is signed up for the Append-DS Opt. Service.

<com.iso_FirstDt> Date Optional – Response Only

Date first resided at address.

This field is only returned on response if the company is signed up for the Append-DS Optional Service.

<com.iso_LastDt> Date Optional – Response Only

Date last resided at address.

This field is only returned on response if the company is signed up for the Append-DS Optional Service.

Airbag Information Aggregate <AirbagInfo>

This aggregate identifies the status of the airbag(s) in a vehicle involved in a claim.

Tag Type Usage Length Description

<AirbagTypeCd> Code List Optional A code indicating the type of airbag. This element uses the AirbagTypeCd code list. Please refer to the Appendix A.

<AirbagStatusCd> Open Code List

Optional A code indicating the status of an airbag following the incident. This element uses the AirbagStatusCd code list. Please refer to the Appendix A.

Adjuster Party Aggregate <AdjusterParty>

This aggregate identifies the adjuster(s) assigned to this claim. There may be multiple adjusters based on line of business, coverage, location, Claims Party, and more; but each ClaimsInjuredInfo, AutoLossInfo, and PropertyLossInfo, may only associated with a single AdjusterParty/ GeneralPartyInfo

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Adjuster Party Aggregate <AdjusterParty>

Tag Type Usage Length Description

<ItemIdInfo> Aggregate Optional As used here, captures identification numbers assigned to the adjuster, in the event there is more than one adjuster on the claim.

<GeneralPartyInfo> Aggregate Optional Not required, but recommended to assist in distribution of return information within your company

<AdjusterPartyInfo> Aggregate Required Repeating

Contains the Coverage/Loss Information for the loss section of the claim. May be repeated for multiple losses handled by the same adjuster.

Adjuster Party Information Aggregate <AdjusterPartyInfo>

This aggregate identifies which coverage and loss the adjuster(s) has been assigned on this claim. It may be repeated for multiple losses.

Tag Type Usage Length Description

@AssignmentRef Identifier Reference

Required This attribute contains an identifier reference to AutoLossInfo, PropertyLossInfo, or ClaimsInjuredInfo to which this adjuster has been assigned.

<CoverageCd> Code List Required C-4 The specific coverage under the policy that the loss is applied against for ClaimsInjuredInfo or AutoLossInfo. PropertyLossInfo does not use this element unless reporting a Boat or Mobil Equip claim.

This element uses the CoverageCd code list. Please refer to the Appendix B.

<LossCauseCd> Code List Required C-4 A code that identifies the general cause of loss, occurrence, injury or illness.

This element uses the LossTypeCd code list. Please refer to the Appendix B.

Appraiser Activity Information <AppraiserActivityInfo>

This aggregate provides Estimate, Appraisal, and/or Valuation information as provided by auto physical damage estimating information providers. The information is returned on a Response in the ClaimInvestigationAddRs for the initiating claim and the MatchDetails for the matching claims.

Tag Type Usage Length Description

<AppraiserActivityDt > Date Optional C-10 The date on which the activity occurred. YYYY-MM-DD

<AppraiserActivityCd> Code List Optional A code identifying the type of activity engaged in by the appraiser. This element uses the AppraiserActivityTypeCd code list.

<AppraiserValueAmt> %Currency Optional C-11 The monetary amount assigned to the item by the appraiser as a result of the estimation, appraisal or valuation.

Auto Investigation Information Aggregate <AutoInvestigationInfo>

This aggregate describes automobile specific information provided to ISO ClaimSearch by the National Insurance Crime Bureau (NICB) which is used to supplement submitted automobile data to assist in claims investigations. All elements in this aggregate are RESPONSE ONLY. Shipping information is returned in the ClaimInvestigationAddRs/ InvestigationInfo/ AutoInvestigationInfo. Impound and Export information is returned as part of the MatchDetails within the Response.

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Auto Investigation Information Aggregate <AutoInvestigationInfo>

Tag Type Usage Length Description

@ImpoundAgencyRef Identifier Reference

Required if there is data

This attribute is an identifier reference to an Impounding Agency. As used here, this references ClaimsParty.

@ImpoundFacilityRef Identifier Reference

Required if there is data

This attribute is an identifier reference to an Impounding Facility. As used here, this references ClaimsParty

@PortOriginRef Identifier Reference

Required if there is data

This attribute is an identifier reference a Port of Origin of a shipment. As used here, this references ClaimsParty. The shipped item would be a vehicle.

<DeliveryDestinationDesc> Element Optional C-35 A description of the place where the item is scheduled to be exported to.

<ShippedConditionDesc> Element Optional Response Only

C-50 Text message concerning the status of the vehicle

<EventInfo> Aggregate Optional Repeating

As used here, may capture the dates of shipment, impound, export, and/or original theft of a vehicle.

<com.iso_PoliceReportNo> Element Optional Response Only

C-20 Impound Update Police Report No. (sent when MatchReturnReasonCd = Q)

<com.iso_ImpoundInfo> Element Optional Response Only

C-100 Impound Update Additional Information (sent when MatchReturnReasonCd = Q)

Auto Loss Information Aggregate <AutoLossInfo>

This aggregate contains details regarding automobiles related to a loss involving an automobile. This aggregate may be repeated up to 100 times per ClaimsParty to provide information as long as each aggregate contains a unique VIN, coverage, and loss type combination. (i.e. One of the fields: VIN; Coverage type; or Loss type; must be unique within the repetition, or the claim will be rejected with an error for duplicate coverage and loss.) Note – @id, @ClaimsPartyRef, VIN, Year, and Make are required fields for auto physical damage or vehicle theft claims, except for third-party claimants with roles of CL, CD, or CP. If reporting one of these role types and the VIN, Year, and Make are not known, you must still report an AutoLossInfo with @id and @ClaimsPartyRef in order to apply the coverage and loss types to the correct ClaimsParty on the claim.

Tag Type Usage Length Description

@id Identifier Required A document unique identifier – Required by ISO as reference point for coverage/loss information in AdjusterPartyInfo and ClaimsPayment Aggregates.

@ClaimsPartyRefs Identifier Reference

Required As used here, references the claims party associated with this vehicle. Only one claims party may be referenced per vehicle.

<VehInfo>

Aggregate Required – see description

This aggregate contains the VIN and Year which are required except for third-party claimants with roles of CL, CD, or CP.

<ManufacturerCd> Code List Required – see description

C-4 The NCIC standard four character code for vehicle make (not required for third-party claimants with roles of CL, CD, or CP). Contact ISO for a list of Make codes.

<ModelCd> Code List Optional C-3 The three character NCIC abbreviation for vehicle model. Contact ISO for a list of Model codes.

<InventoryNumberId> Element Optional Response Only

C-12 Reference number of a vehicle. Only for Impounded Vehicles.

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Auto Loss Information Aggregate <AutoLossInfo> (cont.)

Tag Type Usage Length Description

<AirbagInfo> Aggregate Optional Repeating

<ImpactPointCd> Code List Optional A code that identifies the point of impact on the vehicle. Please refer to the PointofImpactCd code list in Appendix A.

Catastrophe Aggregate <Catastrophe>

If the event giving rise to the claim involved a catastrophe, this aggregate contains a 3-digit code assigned by Insurance Services Office’s Property Claim Service (PCS) Unit to identify the catastrophe. Please contact ISO for the code list.

Tag Type Usage Length Description

<CatastropheCd> Code List Optional C-3 A three digit code assigned by PCS to identify a catastrophe occurrence. Use for CAT losses prior to 2016. For CAT Losses starting in 2016, use new element <com.iso_NewCATCd>

<CatastropheCdSourceName>

Element Optional C-3 The name of the entity or organization whose catastrophe code is being transmitted. Value=”ISO” for ISO PCS members

<com.iso_NewCATCd> Element Optional C-4 A four digit code assigned by PCS to identify a catastrophe.

Claims Driver Information Aggregate <ClaimsDriverInfo>

This aggregate provides additional information about a driver who is a Claims Party in the claim.

Tag Type Usage Length Description

<DriversLicense> Aggregate Optional

<OperatorAtFaultInd> Boolean Optional 1=Indicates if the agency investigating an accident determined that the operator was at fault. 0= Indicates if the agency investigating an accident determined that the operator was not at fault.

Claims Injured Information Aggregate <ClaimsInjuredInfo>

This aggregate is used to report losses related to a specific injury, liability (such as harassment or slander), or 3

rd party property damage (such as a car drives into a building. The damage to the building is reported with the

ClaimsInjuredInfo, not the PropertyLossInfo). This aggregate may be repeated to provide information regarding multiple losses as long as each aggregate is associated with a separate coverage type and loss type combination in the AdjusterPartyInfo and ClaimsPayment aggregates.

Tag Type Usage Length Description

@id Identifier Required A document unique identifier – Required by ISO as reference point for coverage/loss information in AdjusterPartyInfo and ClaimsPayment Aggregates.

<ICDDiagnosticCd> Code List Optional Repeating (max 5) – Request Only

C-6 A code indicating the diagnostic coding provided when medical treatment was rendered. The element uses the International Classification of Diseases (ICD-9) code list.

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Claims Injured Information Aggregate <ClaimsInjuredInfo> (cont.)

Tag Type Usage Length Description

<com.iso_FatalityInd> Boolean Extension

Optional – Request Only

Y – death was a result of the injury N – death was not a result of the injury U – not known if death was the result of the injury

<com.iso_AmbulanceUsedInd>

Boolean Extension

Optional – Request Only

Y – Ambulance service was used N – Ambulance service was not used

<com.iso_DisabledDueToAccidentInd>

Boolean Extension

Optional – Request Only

Use this field for non-worker’s comp claims P – claimant is partially disabled T – claimant is totally disabled

<com.iso_CPT> Code List Optional – Request Only

Code identifying which current procedural treatment was used. Reported by the medical provider. See the CPT code list in Appendix A for further information.

<TimeLostPeriod> %Duration Optional C-5 for Duration Period

This entity is used to capture the loss time start date (EffectiveDt), loss time end date (ExpirationDt), and the total lost days (DurationPeriod)

<EventInfo> Aggregate Optional Repeating

As used here, captures the dates of attorney involvement, retirement, strike, and/or termination. This aggregate uses the Event (ACORD) or EventCd code lists.

<ClaimsInjury> Aggregate Required

Claims Injury Aggregate <ClaimsInjury>

This aggregate provides information related to a specific injury, liability, or 3rd

party property damage.

Tag Type Usage Length Description

<InjuryNatureDesc> Element Required C-50 A description of the alleged injury or damage to property not owned by the insured.

<BodyPartCd> Code List Optional

C-2 A code that corresponds to the affected body part. This element uses the BodyPartCd code list. Please refer to the Appendix A.

<com.iso_ERISAClmInd> Boolean Extension

Optional C-1 Alternative plans that cover employees’ on-the-job injuries

Y - ERISA Type of Claim

N - not ERISA Type of Claim

Claims Occurrence Aggregate <ClaimsOccurrence>

This aggregate contains the basic data relative to a claim as a whole.

Tag Type Usage Length Description

@id Identifier Reference

Required A document unique identifier should only be present on an element when it is being referenced within the stream.

<ItemIdInfo> Aggregate Required InsurerId is required to identify the insurer’s unique claim identifier. CMS Required Field #75. AgencyId is ISO ClaimSearch unique file number for claim on Response

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Claims Occurrence Aggregate <ClaimsOccurrence> (cont.)

Tag Type Usage Length Description

<PolicyRenewalInd> Boolean Optional Y – Renewal N - New

<com.iso_PoliceReportFiledInd>

Boolean Extension

Optional Y – police report filed N – no police report filed

<ClaimsReported> Aggregate Optional Repeating

<LossDt> Date Required C-10 The date the loss occurred. YYYY-MM-DD CMS Field #13

<LossTime> Time Optional C-5 The time at which loss occurred. HH:MM

<IncidentDesc> Element Required C-50 A description of the loss resulting in the claim. If your loss description exceeds 50 bytes it is recommended to use the new element <com.iso_NewExtLossDesc> for additional Loss Description information.

<Addr> Aggregate Required As used here, the Location of Loss State or Country is required. Other address elements are optional. If the loss occurred on a vessel at sea, the WorkCompLossInfo/ VesselCallId may be used in place of the Location of Loss State/Country.

<Catastrophe> Aggregate Optional

<CatastropheLossInd> Boolean Optional 1=Indicates if this loss is associated with a specifically identified catastrophe. 0=the loss is NOT associated with a specifically identified catastrophe

<ProbableIncurredAmt> %Currency

idref

Optional

Repeating

C-11 The estimate of the amount of damage/injury arising from a casualty or vehicle claim. idref references the id of the specific Loss Information aggregate the payment is being applied to for. (ClaimsInjuredInfo or AutoLossInfo only. Not used for PropertyLossInfo.)

<com.iso_SingleVehInvolvedInd>

Boolean Extension

Optional Y – accident involved only one vehicle N – accident involved more than one vehicle

<com.iso_PhantomVehInd> Boolean Extension

Optional – Request Only

Y – not known how or with whom vehicle was damaged N – known how or with whom vehicle was damaged

<com.iso_AccidentWitnessedInd>

Boolean Extension

Optional – Request Only

Y – Accident was witnessed. N – Accident was not witnessed.

<com.iso_MoldInd> Boolean Extension

Optional Y – Claim involves MOLD N – Claim does not involve MOLD

<com.iso_HitAndRunInd> Boolean Extension

Optional Y – Hit and Run N – Not a Hit and Run

<com.iso_StatementOfDisputeInd>

Boolean Extension

Optional – Response Only

Y – There is a citizen dispute on this claim

<com.iso_NICBReferralInd> Boolean Extension

Optional – Response Only

Y - This claim has been referred to NICB Blank = No referral is indicated.

<com.iso_InsurerFraudRingInvestigation>

Boolean Extension

Optional –

Request Only

Y - A party in this claim is the subject of an insurer fraud ring investigation. N – A party in this claim is not the subject of an insurer fraud ring investigation.

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Claims Occurrence Aggregate <ClaimsOccurrence> (cont.)

Tag Type Usage Length Description

<com.iso_ReceiveDt> Date Required – Response Only

ISO Received Date. YYYY-MM-DD This date is used for the Automatic Update process. It does not change for Replacement or Update transactions.

<com.iso_MassTortInd> Boolean Extension

Optional Y – Mass Tort Claim

<com.iso_SelfInsuredInd> Boolean Extension

Optional Required for reporting by TPAs for CMS for WC or Liability. For insurers and self-insureds, this will be derived by ISO. CMS Field#64 Y= the reportable event involves self-insurance as defined by CMS.

N= the reportable event does not involve self-insurance as defined by CMS.

<com.iso_RRECd> Assigned Identifier

Optional C-9 COBC Assigned Section 111 Reporter ID CMS Field

(Required for TPAs for reporting to CMS or for insurers/self-insurers with more than one CMS registration. For customers with more than one RRE, if this code is not populated, the claim will not be sent to CMS. If a company only registers one RRE, this field does not need to be reported.)

<TaxIdentity> Aggregate Optional C-9 TIN of the applicable plan. Required by CMS if RRE has registered more than one TIN for the reporting RRE. If a company only registers one TIN per RRE, this field does not need to be reported. CMS Field #72

<com.iso_SiteId> Assigned Identifier

Optional C-9 CMS Site ID – Used for CMS to specify additional address associated with one TIN. Site IDs are assigned by RRE but must be provided to ISO before sending. Only required if RRE has set up more than one Site ID per TIN. If a company only registers one Site ID per TIN, this field does not need to be reported. CMS Field #73

<com.iso_NewExtLossDesc> Element Optional C-200 Extended text description of the Loss. Can be used to continue the Loss Description from the <IncidentDesc>, or as a separate Loss Description information input.

Claims Party Aggregate <ClaimsParty>

This aggregate contains information regarding any party that has an “interest” or “involvement” in the claim (ex. insured, claimant, AKA, service provider, witness, etc.), except for the adjuster. CMS Required Fields listed here are for Injured Parties. Please see Appendix D – Role Types for further information on specific Service Provider requirements.

Tag Type Usage Length Description

@id Identifier Reference

Required A document unique identifier should only be present on an element when it is being referenced within the stream.

<GeneralPartyInfo> Aggregate Required Name and Address are Required, SSN/TIN, Phone Numbers, Email Address are optional but searchable. CMS Required Fields #5-8, 69

<PersonInfo> Aggregate Optional CMS Required Fields #9, 10

<ClaimsPartyInfo> Aggregate Required This aggregate contains the ClaimsPartyRoleCd

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ClaimsParty Aggregate <ClaimsParty> (cont.)

Tag Type Usage Length Description

<ClaimsDriverInfo> Aggregate Optional

<ClaimsInjuredInfo> Aggregate Optional

Repeating

Required if there is an injury, liability or 3rd party property damage loss. May repeat to report multiple coverages/losses.

<PartyInvestigationInfo> Aggregate Optional

<com.iso_PartyScoringInfo> Aggregate Optional – Response only

This aggregate is only sent to members using the APD FastCheck Optional Additional Service.

<com.iso_ClaimsPartyVehInfo> Aggregate Optional

<com.iso_ClaimDirectorRules> Aggregate Optional – Response only

This aggregate is only sent to members using the ClaimDirector Optional Additional Service.

<com.iso_AppendDS> Aggregate Optional – Response only

This aggregate is only sent to members using the Append-DS Optional Additional Service.

<com.iso_CSLNInd> Boolean Extension

Optional Y = Search CSLN, O = Search OCSE, B = Search Both CSLN and OCSE. Blank = No CSLN or OCSE Search. See Additional Services - CSEA

<com.iso_NewSOD> Element Optional C-200 Statement of Dispute. This field displays statements provided by citizens who dispute information on the claim in the system.

Claims Party Information Aggregate <ClaimsPartyInfo>

This aggregate provides additional information about a claims party.

Tag Type Usage Length Description

@id Identifier Optional A document unique identifier should only be present on an element when it is being referenced within the stream.

<ClaimsPartyRoleCd> Code List Required

A code identifying the role of the ClaimsParty. This element uses the ClaimsPartyRole (ACORD) or the ClaimsPartyRoleCd (ISO) code list. Please refer to the Appendix A.

<RelationshipToInsuredCd> Code List Optional A code identifying the relationship of the driver of the vehicle to the owner of the vehicle. This element uses the DriverRelationshipToOwnerCd code list.

<AccountNumberId> Assigned Identifier

Optional C-16 The loan number assigned by the financial institution.

<SuitFiledInd> Boolean

idref

Optional Repeating

1=Indicates if this party has filed a lawsuit. 0=Indicates party has NOT filed a lawsuit.

This references the ID of the specific Loss Information (ClaimsInjuredInfo, AutoLossInfo, or PropertyLossInfo) aggregate to which the suit applies.

<ClosedDt> Date

idref

Optional Repeating

C-10 Date when this claims party’s portion of the claim was closed. YYYY-MM-DD

This references the ID of the specific Loss Information (ClaimsInjuredInfo, AutoLossInfo, or PropertyLossInfo) aggregate the payment is being applied to.

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Claims Party Relationship Aggregate <ClaimsPartyRelationship>

This aggregate captures information about the relationship(s) between two parties. All fields are required for AKA or Service Provider information to identify the relationship with other parties on the claim. The Code List elements use the ClaimsPartyRole (ACORD) or ClaimsPartyRoleCd (ISO) code lists in Appendix A.

Claims Party Vehicle Information <com.iso_ClaimsPartyVehInfo>

This aggregate contains information regarding the vehicle a claimant was a passenger in.

Tag Type Usage Length Description

<com.iso_OccupantOfVIN> Element Extension

Optional C-20 The VIN of the vehicle that this party was the occupant of.

<com.iso_PhysicalDamageInd> Boolean Extension

Optional Y=There was physical damage to the vehicle this person was an occupant of. N= There was NO physical damage to the vehicle this person was an occupant of.

Claims Payment Aggregate <ClaimsPayment>

This aggregate contains data regarding any reserves that were set or any claims payments made, including to whom the payment was made. This aggregate is used under the ClaimInvestigationAddRq aggregate for casualty and auto claims, and under the PropertyLossInfo/ClaimsSubjectInsuranceInfo aggregate for property. Please refer to Appendix A and Appendix E for further information.

Tag Type Usage Length Description

@id Identifier Required A document unique identifier should only be present on an element when it is being referenced within the stream.

@idref Identifier Required

OR

This references the ID of the specific Loss Information aggregate the payment is being applied to. (Required for AutoLossInfo or ClaimsInjuredInfo. Not used for PropertyLossInfo.)

@ClaimsPartyRef Identifier Reference

Required OR

This references the ID of the specific ClaimsParty to whom the payment was made.

<PaymentTypeCd> Code List Optional Identifies the type of reserve or payment made. This element uses the PaymentType (ACORD) or PaymentTypeCd (ISO) code list. Please refer to the Appendix A.

<ClaimsPaymentCovInfo> Aggregate Optional Repeating

This aggregate contains the payment amounts per coverage code.

<TotalPaymentAmt> %Currency Optional C-11 Total amount of this payment in whole dollars for Casualty, Auto, Watercraft, and Mobile Equipment claims. Not used for Property claims.

Tag Type Usage Length Description

@ClaimsParty1Ref Identifier Reference

Required This attribute is references the first ClaimsParty’s ID.

@ClaimsParty2Ref Identifier Reference

Required This attribute is references the second ClaimsParty’s ID.

<ClaimsPartyRole1Cd> Code List Required C-2 This is the role of the first claim party in this relationship.

<ClaimsPartyRole2Cd> Code List Required C-2 This is the role of the second claim party in this relationship

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Claims Payment Aggregate <ClaimsPayment> (cont.)

Tag Type Usage Length Description

<LossCauseCd> Code List Optional Required when a single claims party has more than one claim and the coverage types are the same, but loss types are different. As used here, provides the specific loss code under which the payment is made. This element uses the LossTypeCd code list. Please refer to Appendix B.

<PaymentDt> Date Optional C-10 Date on which the first claim payment took place. YYYY-MM-DD Only used when PaymentTypeCd=FCP

Claims Payment Coverage Info Aggregate <ClaimsPaymentCovInfo>

This aggregate contains the payment amounts per coverage code. Please refer to Appendix A and Appendix E for further information.

Tag Type Usage Length Description

<CoverageCd> Code List Required A code that identifies a type of coverage. This element uses the CoverageCd code list for casualty and vehicle claims or the Risk (ACORD) code list for 1st party property claims. As used here, provides the specific coverage code under which the payment is made.

<PaymentAmt> %Currency Optional C-11 Total amount of this payment in whole dollars for Property claims. Not used for Casualty, Auto, Watercraft, and Mobile Equipment claims.

<ClaimStatusCd> Code List Optional As used here the current status of this coverage on the claim. This element uses the ClaimStatusCd code list. Please refer to the Appendix A.

Claims Reported Aggregate <ClaimsReported>

This aggregate is used to collect the information about when, by whom, and to whom a claim was reported. This aggregate is only used when you have the information about the date reported or the report number. For Workers’ Compensation claims, this aggregate may be used to indicate when the claim was first reported to the employer (Insured).

Tag Type Usage Length Description

@ReportedByRef Identifier Reference

Required Or

This attribute is an identifier reference to a ClaimsParty that this claim was reported by.

@ReportedToRef Identifier Reference

Required Or

This attribute is an identifier reference to a ClaimsParty that this claim was reported to.

<ReportedDt> Date Optional C-10 The date the incident/occurrence was reported to or by the party referenced above. YYYY-MM-DD

<ReportNumber> Assigned Identifier

Optional C-15 This element contains the official number of the vehicle incident report, filed by the police, fire, or other agency after an automobile accident.

Claims Subject of Insurance Information Aggregate <ClaimsSubjectInsuranceInfo>

This aggregate is used for 1st party property losses including Fire, Theft, and Other Peril. It is not used in

conjunction with boat or mobile equipment claims. It is not used for 3rd Party Property Losses.

Tag Type Usage Length Description

<SubjectInsuranceCd> Code List Optional As used here, a code categorizing the item that is the subject of the claim described, such as building, contents, and stock. This element uses the Risk (ACORD) code list. Please refer to the Appendix A.

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Claims Subject of Insurance Information Aggregate <ClaimsSubjectInsuranceInfo> (cont.)

Tag Type Usage Length Description

<InsuranceAmt> %Currency Optional C-11 The monetary amount of insurance stated on the policy for this subject of insurance.

<ProbableIncurredAmt> %Currency Optional – see description.

C-11 The estimated total amount of a claim. This field is required for 1

st party property fire claims if ISO is

reporting the claims to a State Fire Marshal on member’s behalf.

<ClaimsPayment> Aggregate Optional Repeating

Use this ClaimsPayment to report payments under individual SubjectInsuranceCd’s (ex. one for building and repeated for contents.)

Commercial Name Aggregate <CommlName>

Special characters should not be sent in name fields, except for apostrophe [‘], hyphen [-], or ampersand [&]. See Appendix C – Edits for further information on how special characters are handled in XML and other restrictions on these fields.

Tag Type Usage Length Description

<CommercialName> Element Required C-70 A text representation of the name of a business. CMS Field #69

Communications Aggregate <Communications>

Tag Type Usage Length Description

<PhoneInfo> Aggregate Optional Repeating

<EmailInfo> Aggregate Optional Submitted under <com.iso_SIUParty> for Involved Party or Service Provider. Submitted under <ClaimsParty><GeneralPartyInfo> for Alias.

Coverage Information 1 <com.iso_CovInfo1>

This aggregate is optional for ISO ClaimSearch reporting but contains fields required for CMS Medicare Reporting. This aggregate is not sent within the MatchDetails section of a Response.

Tag Type Usage Length Description

@ItemRef Identifier Reference

Required Intended to refer to the ClaimsInjuredInfo. For companies reporting casualty losses on AutoLossInfo in order to provide the VIN on casualty losses, this may refer to an AutoLossInfo

<com.iso_CMSIncidentDt> Date Optional Date of Incident as defined by CMS – date of first exposure, first ingestion, or first implant. YYYY-MM-DD CMS Required Field #12

<Addr> Aggregate Optional As used here, only <StateProvCd> is required to report State of Venue. The state whose state law controls resolution of the claim. Insert “US” <CountryCd> where the claim is a Federal Tort Claims Act liability insurance matter or a federal WC claim. Insert “FC” <CountryCd> for foreign country. CMS Required Field #17

<com.iso_NFLTLimit> %Currency Optional C-11 No Fault Insurance Limit Dollar amount of limit on no-fault insurance. Specify dollars and cents with implied decimal. Ex. $10,500.00 should be coded as 00001050000. Fill with all 9’s if there is no dollar limit. Fill with all 0’s for WC or Liability claims. Required by CMS for no-fault claims. CMS Field #81

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Coverage Information 1 <com.iso_CovInfo1> (cont.)

Tag Type Usage Length Description

<com.iso_ExhaustDt> Date Optional Exhaust Date for Dollar Limit for No Fault Insurance Date on which limit was reached or benefits exhausted for no-fault insurance limit. YYYY-MM-DD

Fill with zeroes if no-fault limit has not been reached/exhausted or if this is a WC or Liability claim.

Required by CMS for no-fault claims if benefit limit is reached/exhausted. CMS Field #82

<com.iso_ORMInd> Boolean Extension

Optional Indication of whether there is On-Going Responsibility for Medicals (ORM). Y=there is on-going responsibility for medicals N=there is not on-going responsibility for medicals CMS Required Field #98

<com.iso_ORMDt> Date Optional Date on-going responsibility for medicals ended (termination date). YYYY-MM-DD

Only applies to claims submitted with <com.iso_ORMInd> = Y. CMS Field #99

<com.iso_TPOCDt> Date Optional Repeating Max 5

Total Payment Obligation to the Claimant (TPOC) Date. Initial date of total payment obligation to the claimant without regard to on-going responsibility for medicals. YYYY-MM-DD

Required by CMS except for the initial report of a claim reflecting ongoing payment responsibility. CMS Field #100

<com.iso_TPOCAmt> %Currency Optional Repeating

Max 5

C-11 Total Payment Obligation to the Claimant (TPOC) Amount Dollar amount of the total payment obligation to the claimant. Specify dollars and cents with implied decimal. EX: $10,500.00 should be coded as 00001050000. Fill with all 0’s when reporting claims reflecting ongoing payment responsibility unless the responsibility ended due to a settlement. Required by CMS if TPOC Date has been completed. CMS Field #101

<com.iso_TPOCStartDt> Date Optional Repeating

Max 5

Funding Delayed Beyond Total Payment Obligation to the Claimant (TPOC) Start Date. If funding for the total payment obligation to the claimant is delayed, provide actual or estimated date of funding. YYYY-MM-DD CMS Field #102

<ICDDiagnosticCd> Code List Optional Repeating

Max 19

C-6 ICD-9 Code as reported by medical provider. See Appendix A. CMS Field #18-36. Required by CMS for new claims on or after 1/1/11. If reported with decimal, ISO will strip the decimal before sending to CMS. Must be on CMS valid list, not on the excluded list, and must not begin with “E” or “V”.

<com.iso_ICD10Cd> Code List Optional Repeating

Max 19

C-8 ICD-10 Code as reported by medical provider. See Appendix A. CMS Field #18-36. Required by CMS for injuries occurring on or after 10/1/15, but will be accepted by CMS beginning 10/1/14. Prior to 10/1/14, ICD-9 Codes are still required. If reported with decimal, ISO will strip the decimal before sending to CMS. Must be on CMS valid list, not on the excluded list, and must not begin with “V”, “W”, “X” or “Y”.

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Coverage Information 1 <com.iso_CovInfo1> (cont.)

Coverage Information 2 <com.iso_CovInfo2>

This aggregate is optional for ISO ClaimSearch, but contains fields required for CMS Medicare reporting and Mass Tort. This aggregate is not sent within the MatchDetails section of a Response.

Tag Type Usage Length Description

@ItemRef Identifier Reference

Required Intended to refer to the ClaimsInjuredInfo. For companies reporting casualty losses on AutoLossInfo in order to provide the VIN on casualty losses, this may refer to an AutoLossInfo

<com.iso_ProdLiabInd> Boolean Extension

Optional Product Liability Indicator. Indicates whether injury, illness or incident was allegedly caused by/contributed to by a particular product. CMS Field #58 – Currently not being sent to CMS. 1 = No; 2 = Yes, but not a mass tort situation; 3 = Yes, and is a mass tort situation.

<com.iso_GenName> Element Optional C-40 Product Generic Name - Generic name of product alleged to be the cause of injury, illness, or incident. If no generic name, supply the brand name in this field. CMS Field #59 – Currently not being sent to CMS

<com.iso_BrandName> Element Optional C-40 Product Brand Name - Brand name of product alleged to be the cause of injury, illness, or incident.

CMS Field #60– Currently not being sent to CMS

<com.iso_ProdMfr> Element Optional C-40 Product Manufacturer – Maker of Product. CMS Field #61 – Currently not being sent to CMS

<com.iso_AllegedHarm> Element Optional C-200 Description of harm allegedly caused by product. CMS Field #62 – Currently not being sent to CMS

<com.iso_ICD10CauseOfInjuryCd>

Element Optional C-7 This field is an optional CMS field, however if submitted it must be valid. Alleged Cause of Injury (E) codes can only be used when reporting ICD-9 diagnostic codes. Alleged Cause of Injury (V, W, X, Y) codes can only be used when reporting ICD-10 diagnostic codes. CMS Field #15.

Tag Type Usage Length Description

<InjuryNatureDesc> Element Optional C-50 Alleged Injuries – Description of Injuries

<com.iso_CauseofInjuryCd> Code List Optional C-5 ICD-9-CM External Cause of Injury Code, “E Code” describing the alleged cause of injury/illness. DO NOT INCLUDE DECIMAL. Must be on CMS valid list not on the excluded list, and must begin with “E”. Optional for all CMS claims as of 4/22/13. See Appendix A. CMS Field#15.

<com.iso_DeleteFromCMS> Element Optional Y – Send a delete transaction to CMS for this person/coverage. CMS Field #3 to remove a claim from the CMS system. N – Must use “N” to remove the “Y” indicator if claim was touched on ClaimSearch website or system will not remove the “Y” indicator.

<com.iso_NotSendCovCMS> Element Optional Y – Do not include this coverage in the CMS Quarterly Reporting. N – Must use “N” to remove the “Y” indicator if claim was touched on ClaimSearch website or system will not remove the “Y” indicator.

89

Driver’s License Aggregate <DriversLicense>

This can be submitted for Involved Party or Alias, but is searched only if the Involved Party is searched.

Tag Type Usage Length Description

<DriversLicenseNumber> Element Optional C-20 The number on this driver's license.

<LicenseClassCd> Element Optional C-2 A code used to identify Driver’s Licence Class Type. This element uses the LicenseClassCd code list in Appendix A.

<StateProvCd> Code List Optional State code. The source of the code list is the U.S. Postal Service. As used here, the state in which the driver’s license is issued.

Email Information Aggregate <EmailInfo>

This aggregate is optional. It is used to populate the Email Address for an Involved Party, Service Provider, or Alias, depending on placement in XML string. When email address is available for ClaimsInjuredInfo, AutoLossInfo, or PropertyLossInfo you must use @idref.

Tag Type Usage Length Description

@idref Identifier Reference

Optional @Idref is used only for ClaimsInjuredInfo, AutoLossInfo, or PropertyLossInfo references when email address is present.

<EmailAddr> Element Optional C-50 This element is searchable if provided. Must contain @ or the data will be considered invalid.

Employee Information Aggregate <EmployeeInfo>

This aggregate provides additional information about an employee. This information is typically used in Workers’ Compensation claims reporting and/or management to capture information about the employee at the time of the injury or illness.

Tag Type Usage Length Description

@id Identifier Optional This attribute is an identifier to a specific element.

<HiredDt> Date Optional C-10 The date the employee began employment with the employer under which the claim is being filed.

<EmploymentStatusCd> OpenEnum Optional A code used to indicate the employee’s primary work status at the time of the injury with the covered employer. This element uses the EmploymentStatusCd code list in Appendix A.

<com.iso_PreExistingDisabilityInd>

Boolean Extension

Optional – Request Only

Y – Disability existed prior to the injury N – Disability did not exist prior to the injury U – Not known if the disability existed prior to the injury.

<com.iso_EmployedInd> Boolean Extension

Optional – Request Only

Y – The person was employed by the insured N – The person was not employed by the insured.

Event Information Aggregate <EventInfo>

This aggregate is used to collect the information about when a specific event occurred.

Tag Type Usage Length Description

<EventCd> Code List Required A code identifying an event. This element uses the EventCd code list. Please refer to the Appendix A.

<EventDt> Date Required C-10 The date on which the event took place. YYYY-MM-DD

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General Party Information Aggregate <GeneralPartyInfo>

This aggregate provides general name, address and communications information about a person(s) or organization(s).

Tag Type Usage Length Description

<NameInfo> Aggregate See Description Repeating

Required for Claims Party and Service Providers; Optional for AKA Information or Adjuster Party

<Addr> Aggregate Optional – see description Repeating

Address, City, State required for ClaimsParty; City and State required for Service Provider; Optional for AKA information or Adjuster Party. AddressTypeCd required for Mailing or Physical Risk Address under Policy/MiscParty, otherwise this element is not used.

<Communications> Aggregate Optional May be used to report Home Phone, Business Phone, Cell Phone, Pager +PIN, or Fax numbers. Only one Cell Phone Number may be reported per ClaimsParty. Fax number is Request Only.

Item Definition Aggregate <ItemDefinition>

This aggregate is used in various places within the XML string for submitting first party property theft, boat, or mobile equipment claims. The required fields depend on what is submitted in the ItemTypeCd element.

Tag Type Usage Length Description

<ItemTypeCd> Code List Required A code identifying the type of item being defined. This element uses the ItemDefinition or SubjectInsuranceCd code list. Please refer to the Appendix A.

<Manufacturer> Element Required – for boat

C-20 Enter the manufacturer of the boat or if the boat is homemade enter “Home Built”

<Model> Element Optional C-20 The manufacturer model name for this item. – Only use this element for reporting boat claims

<SerialIdNumber> Element Required – for boat or mobile equipment

C-20 Full Product, Hull or Vehicle Identification Number, a unique number, typically the manufacturer’s serial number, identifying the item being described. (VIN/HIN/PIN)

<ModelYear> Long Required – for boat or mobl. equip

C-4 The model year for this item. YYYY

<ManufacturerCd> Code List Required – for mobi equip

C-4 A code that identifies the make of the vehicle. Enter the NCIC standard four character code for vehicle make.

<ModelCd> Code List Required – for mobile equip

C-3 A code that identifies the model of the vehicle. Enter the three character NCIC abbreviation for vehicle model.

<BodyTypeCd> Code List Optional A code indicating the body style of this item. This element uses the WaterUnitTypeCd code list for boats/ VehTypeCd for mobile equipment. Please refer to the Appendix A.

<ChassisSerialNumber> Element Optional C-14 A unique number identifying the chassis of the item being described.

<EngineSerialNumber> Element Optional See Desc.

A unique number identifying the engine of the item being described. C-20 for Boat; C-14 for MoblEquip; See sample files for better understanding of reporting this element.

<TransmissionSerialNumber> Element Optional C-14 A unique number identifying the transmission of the item being described.

<Registration> Aggregate Optional

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Item Id Information Aggregate <ItemIdInfo>

Tag Type Usage Length Description

<AgencyId> Assigned Identifier

See description

C-9 MiscParty Aggregate on Request - An ID assigned by ISO to indicate company and office submitting a claim. Required ClaimsOccurrence/ItemIdInfo on Response – ISO ClaimSearch’s unique file number assigned to the claim. Required

<QueueId> Assigned Identifier

See description

C-4 This element is no longer used. It has been superseded by changes to ISO ClaimSearch backend processes.

<InsurerId> Assigned Identifier

See description.

C-30 MiscParty Aggregate on Request /Response – This element is NOT Submitted within this aggregate. ClaimsOccurrence/ItemIdInfo on Request/Response - The insurer’s unique file number associated with this claim. Required

Item Information Aggregate <ItemInfo>

This aggregate is used when reporting a mobile equipment claim.

Tag Type Usage Length Description

<ItemDefinition> Aggregate Required Required if submitting a mobile equipment claim.

Investigation Information Aggregate <InvestigationInfo>

This aggregate is used on both request and response messages, however some of the elements are only available on the response message from ISO ClaimSearch to your company. These are noted below. In these cases, the usage refers to whether the element is always present on the response or only present if information is available.

Tag Type Usage Length Description

@ItemRef Identifier Reference

Required This references the ID for the specific AutoLossInfo or PropertyLossInfo (for Boat or Mobile Equipment claims).

<ValidVINInd> Boolean Required – response only

Indicates if ISO ClaimSearch has determined that the submitted VIN is valid. This applies to vehicles and mobile/ off road equipment.

<FailedVIN> Element Optional – response only

C-20 If ISO ClaimSearch has determined that the submitted VIN is invalid, contains the submitted invalid VIN. The corrected VIN is then returned in <VehIdentificationNumber>.

Claims with Failed VINs will not be sent to NMVTIS

<VINMissingInd> Boolean Optional 1=Indicates if the item’s VIN plate is missing.

<VehDispositionCd> Code List Optional Identifies the loss status of a vehicle. This applies to vehicles and mobile/ off road equipment. This uses the VehDispositionCd list.

<com.iso_TheftTypeInd> Boolean Extension

Optional P=Partial Theft, T=Total Theft of Vehicle The partial theft indicator should be used whenever contents of a vehicle or major parts are stolen. Partial thefts will not generate recoveries; total thefts will attempt to be recovered. Loss Type: partial=PTFT, total=THFT. Even though this information is not required, its use is important for the Recovery Process.

<EngineMissingInd> Boolean Optional 1=Indicates if the engine was missing at the time of the occurrence.

<TransmissionMissingInd> Boolean Optional 1=Indicates if the transmission was missing at the time of the occurrence.

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Investigation Information Aggregate <InvestigationInfo> (cont.)

Tag Type Usage Length Description

<NCICStatusCd> Boolean Optional – Response (Echo) Only

A = Indicates that a vehicle theft is active in the NCIC system, and the vehicle has not yet been recovered.

<AutoInvestigationInfo> Aggregate Optional – response only

Identifies Impound, Export, or Shipping information

<RecoveryInfo> Aggregate Optional Required if any Recovery Information is reported

<SalvageInfo> Aggregate Optional Required if any Salvage Information is reported

<AppraiserActivityInfo> Aggregate Optional – response only

Identifies Estimation, Appraisal, or Valuation Information

<com.iso_VehRecall> Aggregate Optional Repeating (Max 10)– response only

This aggregate is only sent to members using the NHTSA Vehicle Recall Standard Additional Service.

<com.iso_SFNMVTIS> Aggregate Optional This aggregate is for an internal ISO process. It is not intended for external customers.

<com.iso_NMVTISCheckInd>

Element Optional Response Only

E = This VIN failed validation, but passed check digit validation. It is eligible to be sent to NMVTIS if all other reporting criteria are met.

<com.iso_NonStdVINVerify> Boolean Optional Echo Response Only

Y = VIN submitted is greater than or less than standard 17 digit VIN and therefore cannot be validated. . If value in <com.iso_NMVTISCheckInd> = F AND this field is populated, the vehicle may still be eligible to be sent to NMVTIS, if other NMVTIS criteria are met. Spaces will be sent in all other cases.

Key Reason Information Aggregate <com.iso_KeyReasonInfo>

This aggregate is RESPONSE ONLY and contains information associating a claims party with common fraud indicators. This aggregate will only be returned if key indicators were present for an involved party or service provider.

Tag Type Usage Length Description

@ClaimsPartyRef Identifier Reference

Required This Attribute is required to report involved Party (Claims Party) information for SIU.

@ClaimsParty2Ref Identifier Reference

Optional This Attribute is required to report Service Provider information for SIU.

<com.iso_KeyReasonCd> Code List Required Repeating (Max 15)

C-2 A code identifying the fraud indicator(s) that exist for this party. The source is KeyReasonCd list.

Litigation Information Aggregate <LitigationInfo>

This aggregate only refers to injury, liability, or 3rd party property damage claims where a ClaimsParty has filed a

lawsuit. If the <PlaintiffRefs> refers to an AutoLossInfo or PropertyLossInfo, the information provided will be dropped out in the processing of the claim and not stored on the ClaimSearch system.

Tag Type Usage Length Description

@id Identifier Optional A document unique identifier should only be present on an element when it is being referenced within the stream.

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Litigation Information Aggregate <LitigationInfo> (cont.)

Tag Type Usage Length Description

<PlaintiffRefs> Identifier Reference

Required Refers to the ClaimsInjuredInfo of the ClaimsParty that has filed the lawsuit.

<CourtName> Element Optional C-10 The text name of the court in which the action is to be filed. (ex. Supreme, Federal, District, etc)

<Addr> Aggregate Optional As used here, to report the Court County <County> (C-25) and the Court State <StateProvCd>

<DocketNum> Element Optional C-22 Docket Number of the Court Case.

<ThresholdTypeCd> Code List Optional A code indicating the type of threshold applicable. This element uses the ThresholdType (ACORD) or the TortThresholdTypeCd (ISO) codelist.

<ThresholdStateProvCd> Code List Optional The state whose threshold laws are applicable. The source of this code list is the U.S. Postal Service.

<EventInfo> Aggregate Optional Repeating

Court Filed Date.

Match Details Aggregate <MatchDetails>

The aggregate is a RESPONSE ONLY aggregate and contains details about the matching claim, indicating why the matching claim matched the submitted claim. When a match is made, all of the claim details in each matching claim as submitted by other organizations are sent.

Tag Type Usage Length Description

(%CLAIMSINVESTIGATIONINFO)

Entity Required

<MatchReasonInfo> Aggregate Required Repeating

<com.iso_SumReasonInfo> Aggregate Optional Repeating

Summary Information for Involved Party or Service Provider

<com.iso_KeyReasonInfo> Aggregate Optional Repeating

Key Indicators for Involved Party or Service Provider

<InvestigationInfo> Aggregate Optional Repeating

Match Information Aggregate <MatchInfo>

This aggregate is a RESPONSE ONLY aggregate and contains summary details of the match(es).

Tag Type Usage Length Description

<AdditionalMatchInfo> Aggregate Optional Repeating

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Match Reason Information Aggregate <MatchReasonInfo>

This aggregate is a RESPONSE ONLY aggregate and contains information associating a claims party with the reason for the match.

Tag Type Usage Length Description

@ClaimsPartyRef Reference Identifier

Required This attribute is an identifier reference to a ClaimsParty. As used here, references the party on which the match was made.

<MatchReasonCd> Code List Required Repeating

A code identifying the reason for this match. The source is the MatchReasonCd code list.

Miscellaneous Party Aggregate <MiscParty>

This aggregate provides information about a miscellaneous individual or organization. ISO uses this aggregate to identify the insuring company and office that the claim is coming from. Matching claims on Response files will not display the ItemIdInfo/AgencyId, but will display the company name under GeneralPartyInfo instead.

Tag Type Usage Length Description

<ItemIdInfo> Aggregate Required AgencyId required for ISO assigned company reporting code on Request and Response – echo of Initiating claim

<GeneralPartyInfo> Aggregate Optional Request – used to report SIU Company Name, SIU Investigator Name, and SIU Investigator Business and Cell Phones.

Response - Company Name is provided for matching claims rather than the matching claims’ AgencyId.

<com.iso_SIUInfo> Aggregate Optional – Response Only

This aggregate contains Special Investigation Unit Contact Information for the claim as a whole on Response Only.

<com.iso_AddInfo> Aggregate Optional This aggregate contains the NMVTIS Operator Entity ID

<MiscPartyInfo> Aggregate Required

Miscellaneous Party Information Aggregate <MiscPartyInfo>

This aggregate provides additional information about a role for a miscellaneous individual or organization.

Tag Type Usage Length Description

<MiscPartyRoleCd> Code List Required Value=”CarrierInsurer” for ISO ClaimSearch US members.

Name Information Aggregate <NameInfo>

The Name Information Aggregate allows for the ability to add a name to any person or organization. Special characters should not be sent in name fields except for apostrophe [‘], hyphen [-], or ampersand [&]. See Appendix C – Edits for further information on other restrictions on these fields. CMS Required Fields are for Involved Party roles. See Appendix D – Role Codes for information specific to Service Providers.

Tag Type Usage Length Description

<CommlName> Aggregate Required XOR

The name of any business or organization, unparsed up to 70 characters. CMS Field #69

<PersonName> Aggregate Required XOR

The name of an individual, parsed into first, middle, and surnames. CMS Required Field #6-8

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Name Information Aggregate <NameInfo> (cont.)

Tag Type Usage Length Description

<TaxIdentity> Aggregate Optional Repeating

Social Security Number (individual) or Tax Identification Number (organization) CMS Field #5, if individual

<NonTaxIdentity> Aggregate Optional Repeating

Professional License or Passport Number

Non Tax Identity Aggregate <NonTaxIdentity>

This aggregate contains the unique non tax Id, associated with a person or organization, such as a professional license or passport number.

Tag Type Usage Length Description

<NonTaxIdTypeCd> Code List Optional A code identifying the type of non-tax Id. This element uses the NonTaxIdType code list. Please refer to the Appendix A.

<NonTaxId> Assigned Identifier

Optional See Desc.

A unique identification issued for other than tax purposes. C-15 – Prof. License C-9 – Passport #

Party Investigation Information Aggregate <PartyInvestigationInfo>

Tag Type Usage Length Description

<SuppressMatchInd> Boolean Optional 1=Indicates that the submitter only wants the data for this party added to the database. No search will be completed on this party. The Response will contain the MatchReasonCd of NS. CMS Warning Codes will still be generated for this party.

<SocialSecurityIssuancePeriod>

%DURATION

Optional – response only

The years in which the individual’s social security number was issued. This information is provided to ISO ClaimSearch by the Social Security Administration and is provided on output only.

<SSNValidationCd> Code List Optional – response only

A code identifying the validity of a social security number as determined by the Social Security Administration. The source of this code list is SSNValidationCd code list. This element is provided on output only.

<TINValidationCd> Code List Optional – response only

A code identifying the validity of a social security number as determined by the Social Security Administration. The source of this code list is TINValidationCd code list. This element is provided on output only.

Person Information Aggregate <PersonInfo>

The Person Information aggregate identifies the common information for a person. CMS Required Fields are for Involved Party roles only.

Tag Type Usage Length Description

<GenderCd> Code List Optional C-1 A code indicating gender. This element uses the ACORD Gender code list. CMS Required Field #9

<com.iso_Age> Element Extension

Optional - Response Only

C-3 Only returned f the company is signed up for the Append-DS Optional Service.

<BirthDt> Date Optional C-10 The date of birth for this individual. YYYY-MM-DD CMS Required Field #10

<OccupationDesc> Element Optional C-50 A description of the party’s primary occupation or business.

<com.iso_1stDoctorDt>

Element Optional The date of the first visit to this doctor after the accident. YYYY-MM-DD. This element is restricted to specific Service Provider role codes, see Appendix D – Role Codes.

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Personal Name Aggregate <PersonName>

This is the format for a person’s name, including various prefixes and suffixes. Special characters should not be sent in name fields except for apostrophe [‘], or hyphen [-], or ampersand [&]. See Appendix C – Edits for further information on how special characters are handled in XML and other restrictions on these fields. CMS Required Fields are for Involved Party roles. See Appendix D – Role Codes for information specific to Service Providers.

Tag Type Usage Length Description

<Surname> Element Required C-30 The family name of an individual CMS Required Field #6

<GivenName> Element Required C-20 The first name of an individual CMS Required Field #7

<OtherGivenName> Element Optional C-20 The middle name of an individual CMS Field #8

Personal Vehicle Information Aggregate <PersVehInfo>

Tag Type Usage Length Description

<OdometerReading> %MEASUREMENT

Optional C-10 The odometer reading at the time the insurance policy is applied for. As used here, miles.

<AntiTheftDeviceCd> Code List Optional A code identifying the principal anti-theft device found on the vehicle. This element uses the AntiTheftDeviceCd code list.

Phone Information Aggregate <PhoneInfo>

Tag Type Usage Length Description

<PhoneTypeCd> Code List Required if Phone Number is submitted

The type of phone number. This element uses the PhoneTypeCd code list. Please refer to the Appendix A.

<CommunicationUseCd> Code List Required if Phone Number is submitted

This element describes where and when the communication method is used. This element uses the CommunicationUse code list. Please refer to the Appendix A.

<PhoneNumber> Phone Number

Optional C-14 The phone number. +1-NNN-NNNNNNN[NNNNNNN]

where [NNNNNNN] is optional for the reporting of a Pager PIN number.

<com.iso_PhoneName> Element Extension

Optional – Response Only

C-70 The name as it appears in phone directories. This field is only returned on response if the company is signed up for the Append-DS Optional Service.

<com.iso_PublishedInd> Boolean Extension

Optional – Response Only

Y – The phone number is published N – the phone number is not published

This field is only returned on response if the company is signed up for the Append-DS Optional Service.

Policy Aggregate <Policy>

This “aggregate” has been defined as an entity under the heading Property Casualty Policy Entity (%PCPOLICY). It can be found under the Entity section of this manual. Property Loss Information Aggregate <PropertyLossInfo>

This aggregate is used to report a first-party property loss. Multiple PropertyLossInfo aggregates may be reported on a claim; however the PropertyLossInfo must contain only one <Watercraft> aggregate, OR one <ItemInfo>, OR one or more <ClaimsSubjectInsuranceInfo> aggregates. PropertyLossInfo aggregate should be

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associated with the first ClaimsParty on a claim with multiple claim types or it may not display correctly on ISO ClaimSearch web reports. It is only allowed if the role is Insured, Claimant/Insured, Tenant, Partner, Insured Passenger, or Insured Driver. Note - Please see Summary of XML Request Aggregates in Schema Order for further rules on submitting property claims.

Tag Type Usage Length Description

@id Identifier Required A document unique identifier – Required by ISO as reference point for coverage/loss information in AdjusterPartyInfo and ClaimsPayment Aggregates.

@ClaimsPartyRefs Identifier Reference

Required This refers to the ID of the ClaimsParty that suffered the loss.

<ItemInfo> Aggregate Optional OR

Required if mobile equipment claim

<Watercraft> Aggregate Optional OR

Required if boat or watercraft claim

<PropertySchedule> Aggregate Optional Repeating

Required if property theft claim

<ClaimsSubjectInsuranceInfo>

Aggregate Optional Repeating OR

Required for 1st party property damage including fire, theft, or other peril for Building, Contents, Loss of Use, Stock, or Other

<RealEstateTypeCd> Code List Optional A code indicating the type of real estate being described herein. This element uses the RealEstateTypeCd code list. If “Other” is reported, this element will not be on the Response, only the “Other Desc.” below will show.

<RealEstateTypeOtherDesc>

Element Optional C-35 The description of the building when the RealEstateTypeCd is “Other”.

<LossKindCd> Element Optional Y = This loss includes at least one scheduled item

<ObjectLossDesc> Element Optional C-35 Description of scheduled property

<OccupancyTypeCd> Code List Optional A code identifying the occupancy status of the particular structure. This element uses the OccupancyTypeCd code list.

<IncendiaryFireInd> Boolean Optional Indicates if the fire appears to be incendiary in nature.

<TheftLocationCd> Code List Optional A code identifying the location of the theft. This element uses the TheftLocationCd code list.

<com.iso_ContentTheftInd>

Element Optional Indicates whether contents were stolen from: R = Retail Store C = Cargo/Truck Loss Type must equal THFT. Population of this element will result in notification to CargoNet.

Property Schedule Aggregate <PropertySchedule>

This aggregate identifies items that have been damaged or stolen. Required for 1st party property theft claim.

Optional for all other loss types.

Tag Type Usage Length Description

<IsSummaryInd> Boolean Extension

Required if loss type is theft, Optional for all other loss types

Indicates if item is scheduled, unscheduled or both.

X = unscheduled

S = Scheduled

B = Both

<ItemDefinition> Aggregate Required The SubjectInsuranceCd code list is used to identify stolen items. At least one category from this list must be selected when reporting a property theft claim.

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Recovery Information Aggregate <RecoveryInfo>

This aggregate provides information regarding the recovery of stolen vehicles or boats. This aggregate may include data supplied by the insuring company on a request, or on a response it may contain data as provided by insurance company, police agencies, or National Insurance Crime Bureau (NICB).

Tag Type Usage Length Description

@ItemRef Identifier Reference

Required This references the ID of the vehicle (AutoLossInfo) or boat (PropertyLossInfo) that was stolen.

@RecoveryAgencyRef Identifier Reference

Required if there is data

This references the ID of the ClaimsParty that recovered the vehicle or boat.

<RecoveryStatusCd> Code List See Description

A code identifying the condition of the recovered vehicle. The source of this code list is the RecoveryConditionCd code list (Required for Recovery data – codelistref will not be present on Response) or the RecoveryClassificationCd code list (Optional for Recovery data – codelistref will be present on Response.) This element will repeat if both Condition and Classification are used.

<CannedRecoveryCd> Code List Extension

Required – response only

A code provided by the NCIC regarding the status of a recovered vehicle. This element uses the RecoveryStatusCd List. Information in this field will cause the RecoveryInfo to return outside the <InvestigationInfo> aggregate.

<RecoveryDt> Date Required C-10 The date on which the vehicle was reported as recovered. YYYY-MM-DD

<Addr> Aggregate Required As used here, this is the location where the vehicle was recovered. (Recovery State is required)

<RecoveryLocDesc> Element Required for impounds - response only

C-24 A description of the location where the vehicle was recovered, other than an address. Only for Impounded Vehicles. Information in this field will cause the RecoveryInfo to return outside the <InvestigationInfo> aggregate.

<Communications> Aggregate Optional As used here, provides contact information for the actual location of the recovery, as opposed to the recovery agency.

<com.iso_RecoveryVehNumber>

Element Extension

Optional – response only

C-12 As used here, impound reference number. Information in this field will cause the RecoveryInfo to return outside the <InvestigationInfo> aggregate.

<com.iso_TheftVerification>

Aggregate Optional – Response Only

Additional verification that the insured’s stolen vehicle has been reported to the police.

<com.iso_VehRecoveryInd>

Boolean Extension

Optional - Response only

Y = this is the Vehicle being recovered in a multi VIN theft. Information in this field will cause the RecoveryInfo to return outside the <InvestigationInfo> aggregate.

Registration Aggregate <Registration>

This aggregate collects registration information about boats or vehicles licensed for road use.

Tag Type Usage Length Description

<RegistrationTypeCd> Code List Optional – for vehicles only

As used here, this is a code identifying the type of specialty license plate on a vehicle, such an Antique Car, Diplomatic, etc. Uses the LicensePlateTypeCd code list

<RegistrationNumber> Identifier Optional C-9 for boats C-10 for vehicles

The unique identifier assigned by the registering authority. As used here, License Plate for vehicles; Boat Registration Number for boats.

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Registration Aggregate <Registration> (cont.)

Tag Type Usage Length Description

<StateProvCd> Code List Required if Reg. No. is input

C-2 State code in which the vehicle or boat was registered. The source of the code list is the U.S. Postal Service.

<CountryCd> Code List Optional C-3 Country. Usage is the International Standards Organization code list.

<LastRegisteredYear> Date Optional C-4 The last year in which the item was legally registered. YYYY

Salvage Information Aggregate <SalvageInfo>

This aggregate provides information regarding the salvage of a vehicle, boat or mobile equipment. VIN is an optional field for most auto physical damage claims with a 3

rd party (CL, CD, or CP) claimant role code; however

reporting SalvageInfo for this vehicle makes the VIN a required field.

Tag Type Usage Length Description

@ItemRef Identifier Reference

Optional As used here, this references the ID of the object being salvaged (AutoLossInfo or PropertyLossInfo).

@SalvageAgencyRef Identifier Reference

Required if there is data

XOR

This attribute is an Identifier Reference to a salvage agency. As used here, this references ClaimsParty.

@BuyerRef Identifier Reference

Required if there is data

XOR

This is references the ClaimsParty that is the buyer of the salvaged vehicle, boat, or mobile equipment, if not owner retained or insurance company owned.

<SalvageDt> Date Required C-10 The date when the vehicle was salvaged. YYYY-MM-DD

<ItemAppraisedValueAmt>

%Currency Optional C-11 The appraised value of the salvaged vehicle, provided by the salvage entity.

<ItemValuePriorToLossAmt>

%Currency Optional C-11 The actual cash value of the vehicle prior to the loss, as provided by the salvage entity. This is not necessarily the insured amount.

<ItemValueReceivedAmt>

%Currency Optional C-11 The amount of payment received for the vehicle, as provided by the salvage entity.

<OwnerRetainingSalvageInd>

Boolean Required 1=The owner is retaining the salvaged vehicle.

Special Investigator Aggregate <com.iso_SIUInfo>

This aggregate identifies the Special Investigator Contact Information for the claim as a whole. The entire aggregate is RESPONSE ONLY.

Tag Type Usage Length Description

<GeneralPartyInfo> Aggregate Optional Physical Risk Address and Mailing Address

<com.iso_CommlName> Aggregate Optional SIU Company Name

<com.iso_SurName> Element Optional SIU Investigator Last Name

<com.iso_GivenName> Element Optional SIU Investigator First Name

<com.iso_OtherGivenName> Element Optional SIU Investigator Middle Name

<com.iso_SIUPhoneInfo> Element Optional SIU Phone Info +1-NNN-NNNNNNN

<com.iso_InsurerFraudRingInvestigation>

Boolean Extension

Optional Y/N. Claim is associated with insurer fraud ring investigation.

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Special Investigation Details Aggregate <com.iso_SIUParty>

This aggregate identifies special investigation details and email address that will be associated with either Involved Parties or Service Providers. It also contains CMS Reporting required fields for Claimant Role Codes.

Tag Type Usage Length Description

@ClaimsPartyRef Identifier Reference

Required XOR

As used here, references the claims party associated with the Investigation Details.

@ClaimsParty2Ref Identifier Reference

Required XOR

As used here, references the service provider associated with the Investigation Details.

The following fields may be reported referencing either Involved Party (Insured or Claimant) or Service Provider

<com.iso_SIUInvolved> Boolean Extension

Optional Y – SIU is involved in the claim for this party. N – SIU is not involved in the claim for this party.

<com.iso_ClaimNotPaid>

Boolean Extension

Optional Y - Claim or part of claim for this party was not paid after investigation. N – Claim or party of claim for this party was paid after investigation.

<com.iso_EnforcementActionSubject>

Boolean Extension

Optional Y – Party was subject to an enforcement action (criminal indictment, professional disciplinary). N – party was not subject to an enforcement action (criminal indictment, professional disciplinary)

<com.iso_CriteriaForFraudBureau>

Boolean Extension

Optional Y – Claim for this party meets the criteria for fraud bureau reporting.

N – Claim for this party does not meet the criteria for fraud bureau reporting.

<com.iso_NICBAlert> Boolean Extension

Optional - Response Only

Y – Party associated with NICB alert. N – Party not associated with NICB alert.

This will only appear on the Echo section of the Response

The following fields may only be reported referencing a ClaimsParty with a Claimant role code (CI, CD, CL, or CP)

<EventInfo> Aggregate Optional As used here, to report the Date of Death. Uses EventCd=Death.

<com.iso_MedicareEligibleInd>

Boolean Extension

Optional Y=This involved party is Medicare eligible N= This involved party is not Medicare eligible Space=Unknown

***This field is the main trigger for reporting to CMS. Any time this indicator = Y and the claim meets other criteria for reporting, the party will be reported to CMS. If you do not want the party sent to CMS, you must populate <com.iso_NotSendToCMS> with “Y”. CMS Field

This field will only echo back the Request information; will not be sent on Matching claims.

<com.iso_NotSendToCMS>

Boolean Extension

Optional Y=Do not send this party to CMS.

Use this indicator if you do not want this party sent to CMS because the claim is below the threshold or for other reasons. CMS Field

This field will only echo back the Request information; will not be sent on Matching claims.

<com.iso_HICN> Assigned Identifier

Optional C-12 Medicare Health Insurance Claim Number.

Required for CMS reporting if SSN is not provided. CMS Field #4 This field will only echo back the Request information; will not be sent on Matching claims.

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Special Investigation Details Aggregate <com.iso_SIUParty> (cont.)

Tag Type Usage Length Description

<com.iso_StopCMSQuery>

Boolean Extension

Optional Y=Stop querying CMS to determine Medicare eligibility for this party. You may wish to stop the query if the claim is closed after the threshold dates and you do not expect to have further responsibility. CMS Field

This field will only echo back the Request information; will not be sent on Matching claims.

The following fields may be reported referencing either Involved Party (Insured or Claimant) or Service Provider

<Communications> Aggregate Optional As used here, will populate the Email Address for the above referenced <ClaimsParty>. This is not used for Alias Email Address.

Special Investigator Phone Information Aggregate <com.iso_SIUPhoneInfo>

This aggregate contains phone information for the special investigator. The entire aggregate is RESPONSE ONLY.

Tag Type Usage Length Description

<PhoneTypeCd> Code List Optional The type of phone number. This element uses the PhoneTypeCd code list. Please refer to the Appendix A.

<CommunicationUseCd>

Code List Optional This element describes where and when the communication method is used. This element uses the CommunicationUse code list. Please refer to the Appendix A.

<PhoneNumber> Phone Number

Optional The phone number for the special investigator. +1-NNN-NNNNNNN

Summary Reason Information Aggregate <com.iso_SumReasonInfo>

This aggregate is RESPONSE ONLY and contains information associating a claims party with the reason for the match.

Tag Type Usage Length Description

@ClaimsPartyRef Identifier Reference

Required This Attribute is required to report Involved Party (Claims Party) information for SIU.

@ClaimsParty2Ref Identifier Reference

Optional This Attribute is required to report Service Provider Information for SIU.

<com.iso_SumIdentifier> ISO File Number

Required Repeating (Max 16)

C-11 ClaimSearch Identification Number of Matching Report

<com.iso_SumReasonCd> Code List Required Repeating (Max 16)

C-18 A code identifying the reason for this match. The source is the SumReasonCd list.

<com.iso_TotalLossType> Element Optional C-2 Total # of Matches by Loss Type

<com.iso_TotalSIUInvolvement>

Element Optional C-2 Total # of Matches for SIU Involvement

<com.iso_TotalName> Element Optional C-2 Total # of Matches by Name

<com.iso_TotalAddress> Element Optional C-2 Total # of Matches by Address

<com.iso_TotalSSN> Element Optional C-2 Total # of Matches by SSN

<com.iso_TotalPhone> Element Optional C-2 Total # of Matches by Phone

<com.iso_TotalDriversLic> Element Optional C-2 Total # of Matches by Drivers License

<com.iso_TotalVIN> Element Optional C-2 Total # of Matches by VIN

<com.iso_TotalLicPlate> Element Optional C-2 Total # of Matches by License Plate

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Tax Identity Aggregate <TaxIdentity>

This aggregate contains the unique tax ID assigned by government and associated with a person or organization.

Tag Type Usage Length Description

<TaxIdTypeCd> Code List Required A code identifying the type of tax Id. This element uses the TaxIdType code list.

<TaxId> Assigned Identifier

Required C-9 SSN or TIN. SSN’s will be masked on Response and Stylesheet files. Responses will be in format >000005491<. Stylesheet files will display in format XXX-XX-5491 SSN =CMS Field #5

<StateProvCd> Code List See Desc C-2 The state where the ID was issued. (RESPONSE ONLY)

Vehicle Information Aggregate <VehInfo>

Tag Type Usage Length Description

@id Identifier Optional A document unique identifier should only be present on an element when it is being referenced within the stream.

<Manufacturer> Element Optional C-35 A description of the make of either a vehicle, piece of machinery, boat, mobile home, etc.

<Model> Element Optional C-35 The manufacturer model name for this item.

<ModelYear> Long Required C-4 The model year for this item. YYYY (not required for 3rd party claimants with roles of CL, CD, or CP).

<VehBodyTypeCd> Code List Optional A code indicating the body type of this vehicle. This element uses the VehStyleCd code list.

<VehTypeCd> Code List Optional` A code identifying the predominant type of the vehicle. This element uses the VehTypeCd code list.

<Registration> Aggregate Optional

<VehIdentificationNumber>

Element Required C-20 Full VIN assigned to the vehicle by the manufacturer. This is not required for third party claimants with roles of CL, CD, or CP, UNLESS

Loss Type is THFT

Multiple vehicles are reported for a single party

If this <AutoLossInfo> is referenced by <SalvageInfo>

If the claim is to be reported to NMVTIS In these cases, VIN is required regardless of role code.

<ChassisSerialNumber> Element Optional C-14 Serial Number of the Chassis if not VIN derived.

<EngineSerialNumber> Element Optional C-14 Serial Number of the Engine if not VIN derived or not the original engine.

<TransmissionSerialNumber>

Element Optional C-14 Serial Number of the Transmission if not VIN derived or not the original transmission.

<ColorCd> Code List Optional A code identifying the color of the vehicle. This element uses the VehColorCd code list.

<PersVehInfo> Aggregate Optional

<com.iso_RentedVehInd>

Boolean Optional 1=Indicates that the vehicle was rented

Vehicle Theft Verification Aggregate <com.iso_TheftVerification>

This aggregate will be returned to Auto participants authorized to receive LEMD (Law Enforcement & Manufacturer’s Data) with additional verification that their insured’s stolen vehicle has been reported to the police. After receipt of a theft claim, the National Crime Information Center (NCIC) database used by police

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agencies will be searched for information matching the VIN on the theft claim. When activity is found the Vehicle Theft Verification Aggregate will be returned. You will no longer receive this aggregate, once a recovery has been made.

Watercraft Aggregate <Watercraft>

This aggregate contains information relating to a specific watercraft.

Workers Compensation Loss Information Aggregate <WorkCompLossInfo>

This aggregate accumulates the data required to file a first report of injury for Workers’ Compensation.

Tag Type Usage Length Description

@id Identifier Required if aggregate is used.

A document unique identifier – Required by ISO as reference point.

<WCClaimTypeCd> CodeList Optional Use this field for workers’ comp claims. A code that identifies the payment being made. This element uses the BenefitTypeCd code list.

<SecondInjuryFundInd> Boolean Optional Indicates if the employer was reimbursed by a second injury fund.

<EmployeeInfo> Aggregate Optional

<VesselCallId> Assigned Identifier

Optional A unique assigned radio call sign for a vessel As used here, applies to losses under the Jones Act. May be used in place of Location of Loss State/Country reported on Claims Occurrence/Addr for losses occurring at sea..

Tag Type Usage Length Description

<com.iso_NCICDt > Date Required Date entered into the police system.

<com.iso_PoliceAgency> Element Required C-37 Police Agency who entered the NCIC record

<com.iso_OCA> Element Required C-15 Case number assigned by Police Agency

Tag Type Usage Length Description

<WaterUnitTypeCd> Code List Required A code identifying the type of watercraft. This element uses the WaterUnitType code list.

<ItemDefinition> Aggregate Required – limited repeating

ISO extension allows this to be repeating (to account for information such as multiple engines on a boat…Engine Manufacturer)

<Length> %Measurement

Optional C-2 The length of the boat in feet. If boat is larger than 99 feet, the field may be maxed out at 99 or not reported.

<Horsepower> %Measurement

Optional C-20 The numeric value of the horsepower of the engine/motor of the unit.

<HullMaterialTypeCd> Code List Optional C-2 A code describing the type of hull material of the watercraft. This element uses the HullMaterialTypeCd code list.

<Registration> Aggregate Optional

<PropulsionTypeCd> Code List Optional C-2 A code describing the type of propulsion used by the watercraft. This element uses the PropulsionTypeCd code list.

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UPDATE REQUEST AGGREGATES

Claims Update Aggregate <com.iso_Update>

This aggregate contains information indicating an update to a claim. The aggregates requiring an update should immediately follow this aggregate. (See Replacements and Updates for further information.)

Tag Type Usage Length Description

<com.iso_UpdateInd> Element Extension

Required C-1 See Claims Update Indicators in code list section. Note this is not a code list.

<com.iso_OriginalFields> Aggregate Extension

Required – See description

Required for Indicators 2, 3, 5, or 6. Not used for Indicators 1 or 4.

Claims Update Original Fields Aggregate <com.iso_OriginalFields>

This aggregate contains the original data for fields that will be updated in a Claims Update. The Key Fields aggregate is only used for UpdateInd 5 – Changing Key Fields. The name aggregates are only used for UpdateInds 2, 3 and 4 (for ClaimsParty search) to identify the claims party being updated. (See Replacements and Updates for further information). NAMES MUST BE SENT EXACTLY AS THEY RESIDE IN THE SYSTEM IN ORDER TO COMPLETE THE UPDATE REQUEST.

Tag Type Usage Length Description

<com.iso_KeyFields> Aggregate Required This aggregate is REQUIRED if changing Key Field information (UpdateInd=5)

<CommlName> Aggregate Optional XOR

This aggregate is REQUIIRED if updating an individual claims party that is a business.

<PersonName> Aggregate Optional XOR

This aggregate is REQUIIRED if updating an individual claims party that is an individual.

Claims Update Original Key Fields Aggregate <com.iso_KeyFields>

This aggregate contains the original data for ISO key fields that will be updated in a Claims Update. This aggregate is only used for UpdateInd 5 to identify the original information submitted on the claim. (See Replacements and Updates for further information.)

Tag Type Usage Length Description

<PolicyNumber> Element Required C-30 Insurer’s Policy Number as originally submitted to ISO ClaimSearch

<ItemIdInfo> Aggregate Required C-30 Uses AgencyId to indicate the ISO Assigned reporting code to indicate the company and office the claim was originally reported under; and the InsurerId to indicate the insurer’s Claim Number as originally submitted to ISO ClaimSearch

<LossDt> Date Required C-10 Date of Loss as originally submitted to ISO ClaimSearch. YYYY-MM-DD

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ADDITIONAL SERVICES

Additional Services are offered to all ISO ClaimSearch XML Format customers. The Standard services listed below are part of the standard membership contract and are offered at no additional cost. These services may simply require additional programming to gain the benefits of this service. The Optional services require an additional signed agreement and may require additional programming to gain the benefits of the service. The sections that follow address the general purpose of the service, the technical aspects of how to program these services into your transmissions, and the aggregates used by those services. For pricing of the individual services, please contact your ISO ClaimSearch sales representative. (If you do not know your ISO ClaimSearch sales representative, please contact our Customer Service team at 800-888-4476 or njsupport@iso.com.) Standard Additional Services Offered: Account Management Reports Mandatory – Statutory Reporting For The Industry NHTSA Vehicle Recall National Motor Vehicle Title Information System (NMVTIS) Optional Additional Services Offered: Append-DS

SM

Child Support Enforcement Agency (CSLN/OCSE) Reporting ClaimDirector

SM

Marine Index Bureau Claims Medicaid Reporting Service (MAIS) Medicare Secondary Payer Reporting Service (CMS) OFAC Compliance Solutions NOTE – In the following section of this manual, any reference to Universal Format or UF applies to claims submitted in either the ISO proprietary Universal Format or the ACORD industry-standard XML Format.

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Standard Additional Services

ACCOUNT MANAGEMENT REPORTS

As part of our continued efforts to provide clients with critical information in real time, ISO ClaimSearch offers the ability to view and download online management reports. Authorized management personnel can access and view management reports on the ISO ClaimSearch website through the Account Management hyperlink at the top of any page. The following reports are currently available: CORE SERVICES ISO ClaimSearch Management Reports

The Integrated Statistics Report – provides high level summary and detailed information concerning company monthly and year-to-date activity. The report provides information on claims reporting for all services or database segments in which your company participates (Casualty, Property, and Auto) and for reporting formats – Monoline (legacy) and Universal Format. Details of Vehicle Theft, Salvage, and NMVTIS reporting are also found within this report on a company level.

The Online Utilization Report – a monthly report that provides summary and detailed information

concerning online company and user activity. The report indicates who accessed the system during the period, their last activity date, the number of logons to the system, and what type of activity the user performed (i.e., Claims Reporting, Claims Inquiry, or NICB Referrals).

The Executive Analysis Report – a quarterly report that provides an accounting of claims reported to

ClaimSearch on a group and company level and compares (benchmarks) this experience against industry totals.

ISO ClaimSearch Billing Report – provides online access to the transaction-based billing detail in

invoices for non-insurance company participants. All activities such as claims reporting and claims inquiry are itemized for each transaction processed through the system.

OPTIONAL SERVICES Medicare Secondary Payer Reports – Members who subscribe to the Medicare Secondary Payer

Reporting Service and have been given access to CMS Account Management will receive the results of the monthly CMS Query file and quarterly Acknowledgements and Errors generated as a result of the reporting to CMS. Recently added functionality will now show claimants who are marked as Medicare Eligible Indicator = Y, quarterly statistics, an Active Warning report, and a new dashboard for easier understanding.

ClaimDirector Account Management – Members who subscribe to the ClaimDirector Optional Service have access to the ClaimDirector Customizer, ClaimDirector Management Reports (monthly reports of scores received on claims that can be used to trend the scores), and ClaimDirector Billing Detail (for claims submitted for scoring via the website).

Decision Net

® Account Management – Members who subscribe to the Decision Net Optional Service have

access to the Decision Net Billing Detail (monthly invoices showing the transactions per user per office). Service Information ISO ClaimSearch Core Services Management Reports are part of the standard ISO ClaimSearch membership agreement and only require access to the Account Management section of the ISO ClaimSearch website. ISO ClaimSearch Optional Services require subscriptions to the appropriate services as well as access to the Account Management section of the ISO ClaimSearch website. For further information on access requirements and authorization procedures, please contact ISO ClaimSearch Customer Support.

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MANDATORY – STATUTORY REPORTING FOR THE INDUSTRY

Data Provided to State Agencies ISO ClaimSearch represents the industry and individual subscribers in ongoing interaction with fraud bureaus and/or fire marshals. In addition, most fraud bureaus have direct access to the system for their investigations. Auto Reporting Services Theft and Salvage Claims Reporting to ISO ClaimSearch satisfies requirements for reporting theft and salvage claims in six states: California Massachusetts New York Connecticut New Jersey Rhode Island New York - Auto Physical Damage The state of New York requires reporting of all first party and third party auto physical damage claims of $2,500 or more to a centralized database, such as ISO ClaimSearch, or direct to the State. Pennsylvania - Auto Liability

Pennsylvania requires the membership in, and reporting of all motor vehicle insurance claims data to, a comprehensive database system. Participation in ISO ClaimSearch fulfills this requirement. New Jersey - Auto Accidents The New Jersey Office of the Insurance Fraud Prosecutor requires the reporting of all auto accidents to ISO ClaimSearch via the system's Universal Format. Casualty Reporting Services California Regulation 2698, Claims Analysis Bureau Reporting The ISO ClaimSearch system functions as a Claims Analysis Bureau (CAB) for the California Department of Insurance under California Insurance Law 953: Regulation 2698. The system maintains the required reporting of auto liability, medical payments and uninsured motorist bodily injury claims on California auto policies. Statutory Reporting for New York State Department of Social Services In New York, reporting to ISO ClaimSearch meets the requirement to provide copies of all bodily injury claims (other than workers compensation, medical malpractice and no-fault) to the Department of Social Services to assist in the identification and reporting of all income for New York public assistance recipients. Statutory Reporting for Connecticut Department of Administrative Services Reporting to ISO ClaimSearch meets the requirement in Connecticut for all insurers to notify the Department of Administrative Services (DAS) when a liability claim that may result in a monetary award is filed by a resident of the state. ISO ClaimSearch provides the Connecticut personal injury and workers' compensation claims it receives to the DAS on behalf of participants. New Jersey - Auto Accidents The New Jersey Office of the Insurance Fraud Prosecutor requires all insurers that write in excess of $2,000,000 in personal auto coverage to report all auto accidents involving bodily injury claims and auto physical damage in excess of $2,000 to ISO ClaimSearch via the system's Universal Format. Pennsylvania- Motor Vehicle Insurance Claims

Pennsylvania requires reporting of all auto insurance claims to a central database. Participation in, and reporting auto claims to, ISO ClaimSearch fulfills that requirement. Property Reporting Services ISO staff works with state fire marshals to report on behalf of subscribers where there are mandatory reporting requirements for fire and other losses. Reporting to ISO ClaimSearch satisfies the fire reporting requirements in 21 states. The states are: Alaska Idaho Massachusetts New Mexico

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Arizona Illinois Michigan New York Delaware Kansas Montana North Dakota Florida Kentucky Nebraska Tennessee Georgia Maryland New Hampshire Washington Fire Loss Reporting In 17 states, copies of Property reports are sent on behalf of customers to the state fire marshal on a monthly or quarterly basis. Reports are provided in hard copy or electronically. The list below shows the states and indicates those that receive electronic (e) reports. Arkansas Kansas Michigan (e) New Mexico Delaware Kentucky (e) Montana North Dakota Georgia Maryland Nebraska (e) Tennessee (e) Idaho (e) Massachusetts (e) New Hampshire (e) Washington (e) West Virginia NOTE – Although Estimated Loss Amount is not required for ISO ClaimSearch, individual state fire marshals may require this field on all 1

st party fire losses per state law. These state fire marshals may send their own

rejection reports on claims that do not meet this requirement. Property System Participation In New York State, all companies licensed to write fire business must participate in ISO ClaimSearch - Property. Questionable Claims Reporting Referring to State Fraud Bureaus ISO ClaimSearch and NICB System participants can refer questionable claims through ISO ClaimSearch to the NICB's Questionable Claims Database, and through the NICB, to state fraud bureaus. Twenty-four states accept questionable claims referrals from the NICB: Alabama Idaho Missouri South Carolina Alaska Illinois** Montana South Dakota Arizona Indiana Nebraska Tennessee Arkansas Iowa Nevada Texas California Kansas New Hampshire Utah Colorado* Louisiana New Mexico Vermont Connecticut Maine North Carolina Virginia Delaware Maryland North Dakota Washington District of Columbia Massachusetts Ohio West Virginia Florida Michigan Oklahoma Wyoming Georgia Minnesota Oregon Hawaii Mississippi Puerto Rico * Questionable claims go to the Attorney General for investigation and prosecution and it is not a substitution for the Department of Insurance requirements. ** NICB serves as the State of Illinois’ Questionable Claim Database Referring to State Fire Marshals Similarly, participants can refer questionable or suspicious fire claims to fire marshals in eight states:Illinois Louisiana New Mexico West Virginia Iowa Montana Texas Wyoming Service Information Mandatory-Statutory Reporting is part of the standard ISO ClaimSearch membership agreement. Any additional programming required is dependent on individual statutes and the types of claims reported to the database.

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NATIONAL HIGHWAY AND TRAFFIC SAFETY ADMINISTRATION (NHTSA) VEHICLE RECALL

ClaimSearch has the ability to search against the NHTSA files to determine if there are any potential recalls on all 1

st party vehicles reported within a claim. For customers who are interested in obtaining recall information,

the Recall Information Indicator <com.iso_RecallRqInd> on the <ClaimInvestigationAddRq> aggregate must be set to “Y” for each claim to be searched. ClaimSearch will attempt to obtain the Make and Model of the vehicle by decoding the VIN submitted. The NHTSA file will be searched by Make, Model and Year. If the VIN cannot be decoded, the Make & Model description (if submitted by the customer) and Year will be used to perform the search against NHTSA. Vehicles reported for all insured roles (IN, CI, ID, IP, or IE) will be searched. If a recall was requested, the Recall Information Indicator on <com.iso_RecallRqInd> on the <ClaimInvestigationAddRs> aggregate will contain a “Y”. The information obtained from NHTSA will be returned on the <com.iso_VehRecall> aggregate within the <InvestigationInfo> with an ItemRef referencing the <AutoLossInfo> searched on. If more than one recall is found, this aggregate will be repeated up to 10 times per vehicle. If no recalls are found, this aggregate will still be returned, showing the Year, Make and Model which were searched, as well as a message in the Summary <com.iso_RecallSum> stating: “A search of the NHTSA database produced no recalls on this vehicle, due to the absence of a recall, or the inability to identify this vehicle in the NHTSA database.” File Organization <com.iso_VehRecall> - Echo of NHTSA Vehicle Recall Information illustrates the layout for vehicle recall information. It will be returned within the InvestigationInfo aggregate with an ItemRef referring to the AutoLossInfo of the vehicle searched. It may be repeated up to 10 times, if more than one recall is found. Match File Hierarchy <ClaimInvestigationAddRq> <Policy> <ClaimsOccurrence> <ClaimsParty> Insured <ClaimsParty> Claimant <AdjusterPartyInfo> <AutoLossInfo id=”AutoLossInfo-01” ClaimsPartyRef=”Insured”> <ClaimsPayment> <InvestigationInfo> <com.iso_VehRecall ItemRef=”AutoLossInfo-01”> (if no recall or one recall is found) <com.iso_VehRecall ItemRef=”AutoLossInfo-01”> (if more than one is found, may repeat 10 times) <com.iso_RecallRqInd>Y</com.iso_RecallRqInd> </ClaimInvestigationAddRq>

Service Information NHTSA Vehicle Recall Information is part of the standard ISO ClaimSearch auto membership agreement, but requires additional programming to gain the benefit of this service.

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NATIONAL MOTOR VEHICLE TITLE INFORMATION SYSTEM (NMVTIS)

Effective March 31, 2009, insurers are required to report vehicle total loss claims to NMVTIS. In order to comply with the NMVTIS final rule, we are providing the guidelines below for Universal Format submissions. ISO will report claims to NMVTIS on a daily basis. Claims will be sent 30 days after we receive the claim with a total loss indicator present on the <InvestigationInfo> (see Facts about NMVTIS Reporting below). Vehicles for the current model year and 4 prior years will be reported (i.e. in 2012, all vehicles from 2012 and going back to 2008 will be reported). Automobiles are defined as 4 wheels under 10,000 lbs. Companies may choose to opt-out of this service. However, in doing so, they are required to meet the statutory requirements through other means. ISO ClaimSearch recommends a review of this choice by the member company’s own legal advisors. If the determination is made to opt-out, please contact claimsearchnmvtis@iso.com to ask for an official request form. NMVTIS REQUIRED FIELDS: 1. Vehicle Identification Number of the total-loss automobile (AutoLossInfo/ VehInfo/ VehIdentificationNumber) 2. The date on which the automobile was obtained or designated as a junk or salvage automobile. ISO will

report the date that we receive the Vehicle Disposition (InvestigationInfo/ VehDispositionCd– requires codelistref) as “T” per our system tables.

3. The name of the individual or entity from whom the automobile was obtained (owner name or lien holder name and who possessed the automobile when it was designated a junk or salvage automobile). This name will be taken from the ClaimsParty record referenced by the AutoLossInfo marked as a Total Loss in the corresponding InvestigationInfo.

4. The name of the owner of the automobile at the time of the filing of the report with NMVTIS. This may be the owner, the insurance company, or a 3

rd party salvage buyer. (See descriptions below for what is

required in each of these cases.)

ISO ClaimSearch Requirements for NMVTIS Reporting The submission of an NMVTIS claim follows ISO ClaimSearch basic service rules. This includes Policy and ClaimsOccurrence aggregates for the Universal Common Elements, a ClaimsParty aggregate for each Involved Party to the loss, and at least one AutoLossInfo referring to the ClaimsParty aggregate of the individual or entity from whom the automobile was obtained. An InvestigationInfo/ SalvageInfo aggregate may also be required depending on who is the owner at the time of NMVTIS reporting. ISO REQUIRED FIELDS: Parties to loss (Insured, Claimant, Owner) Policy, Coverage, and Loss Types VIN (must pass validation edit and/or check digit) Total Loss Indicator Owner Retaining Salvage NMVTIS Required Fields (see Sample File – 1

st Party Auto Salvage NMVTIS.xml)

1. ClaimsParty aggregate for each involved party. This may include at least one for the insured and one for the claimant, OR a single record for a claimant/insured.

2. AutoLossInfo/ VehInfo/ VehIdentificationNumber must contain a valid VIN. (ISO is required in its consolidator function to validate this information before sending it.)

3. InvestigationInfo referencing the AutoLossInfo in #2 above. a. VehDispositionCd MUST HAVE A CODELISTREF and must be set to T for Total Loss.

NOTE – This is the trigger for ISO to identify a record that should be submitted to NMVTIS. b. SalvageInfo/ OwnerRetainingSalvageInd must be set to “1” to show owner is retaining salvage.

3rd Party Salvage Buyer NMVTIS Required Fields (see Sample File – 3rd Party Auto Salvage NMVTIS.xml)

The same as the Owner Retaining Salvage above EXCEPT SalvageInfo/ OwnerRetainingSalvageInd must be set to “0,” the SalvageInfo @BuyerRef should reference a ClaimsParty with the Salvage Buyer’s name and a ClaimsPartyRoleCd of “SalvageBuyer” (no codelistref). No <ClaimsPartyRelationship> aggregate is required. Insurance Company Owner NMVTIS Required Fields (see Sample File – Ins Co Auto Salvage NMVTIS.xml) The same as the Owner Retaining Salvage above, EXCEPT SalvageInfo IS NOT SENT in this case. If the Vehicle Disposition Field is set to T and no SalvageInfo is present, ISO will send the Insurance Company

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information to NMVTIS by default. The information is derived from the Insuring Company Code (AgencyId). Programming Notes If you want to report the owner of the vehicle as neither an insured nor claimant you may submit a ClaimsParty with a ClaimsPartyRoleCd set to a role of OW referenced by the total loss AutoLossInfo. This role is in addition to the insured and claimant roles you must submit for the ISO ClaimSearch basic service. If you choose to submit an OW role, then the vehicle information will not be searched in the ClaimSearch database. To have the vehicle information searched you would need to submit a separate AutoLossInfo (without the VehDispositionCd set to T) referencing one of the other ClaimsParty aggregates with a searchable role type. ISO recognizes that some states include unrecovered theft as a total loss. For NMVTIS, we will not look at total theft. To ensure ISO sends a claim to NMVTIS, add total theft (THFT) as a loss type, with comprehensive (COMP) as coverage, but set the Theft Type Indicator (InvestigationInfo/ com.iso_TheftTypeInd) to “T” for total theft and the Vehicle Disposition (InvestigationInfo/ VehDispositionCd) to “T” for total loss. It is recommended that for Total Losses occurring as part of a General Liability claim the vehicle loss should be reported as a CAPP, commercial auto policy type. NMVTIS may accept claims for vehicles which fail the overall VIN check, but the Check Digit value is correct, if all other reporting criteria are correct. To this end, ISO has now added a new indicator <com.iso_NMVTISCheckInd> that will display if the VIN meets this criterion. This indicator will display an “E” on the Response file or “VIN passed check digit” on the stylesheets. NMVTIS Options ISO ClaimSearch provides this service as part of our basic Auto layer. All insurers are automatically enrolled to send all required fields. However you may choose to report only required fields, report required and optional fields, or to opt out of this service. If you choose to report only the required types we will identify these by the Vehicle Type field <VehTypeCd> in the VehInfo aggregate. The valid types are Light Truck (LT), Multi-Purpose (MP), Passenger Car (PC) and Truck (TK), or if the field is left blank. All other types will not be reported for companies who choose to report only the required vehicle types. If you choose to report optional fields of information to NMVTIS, the fields will include the Vehicle Make <ManufacturerCd>, Vehicle Model <ModelCd>, Vehicle Year <ModelYear>, Vehicle Style <VehBodyTypeCd>, Odometer Reading <OdometerReading> and Cause of Loss <LossTypeCd>, if present. Facts about ISO NMVTIS reporting The reporting requirements apply to insurers; self-insurers are not included in the legislation. Claims submitted by TPAs must be reported with the carrier’s ClaimSearch reporting code to be reported to NMVTIS. An Insurer Operator code assigned by ISO for NMVTIS purposes will identify each insurer for reporting. This will be assigned and maintained by ISO and will not have to be passed by insurers on the individual claims. ISO will report claims to NMVTIS on a daily basis. Claims will be sent 30 days after we receive the claim with a total loss indicator present on the InvestigationInfo aggregate. Reports will include all applicable vehicles for 30 days prior. This means on April 1

st we would report March 1

st reported total losses, April 2

nd we would report

March 2nd

and so on. This provides users the opportunity to remove the total loss indicator if the vehicle is subsequently determined to not be a total loss. SALVAGE REPORTING Salvage companies (salvage pools, salvage yards, junk yards, crushers, etc) are to report all salvage disposition under a salvage company code and operator code. The reporting of salvage after sale of salvage under current salvage procedure will not satisfy total loss reporting requirements. A separate layout is used by salvage companies.

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Optional Additional Services

APPEND-DSSM

Append-DSSM

is an optional service specially designed for customers reporting claims in Universal Format. Including a claimant’s Social Security Number (SSN) in search criteria on a claim can significantly increase the effectiveness of system searches and the amount of information returned for claim evaluation. Through the standard Append-DS service, if a claimant is reported without an SSN on an initial claim, Append-DS automatically triggers a public records search to find this key data. When available, the SSN is then used to enhance ClaimSearch database searches for matching claims. In addition to SSN’s, Append-DS will also retrieve other public record details available on the claimant, including the claimant’s current and previous addresses (up to four), phone number, age and date of birth – and add that information to the Search Result report as well. This will cause SSN to show as a Reason for Match even if no SSN was submitted on the claim. NOTE – the SSN and other public records information is NOT automatically added to the claim information stored on our database. The Public Records Information is returned in the <com.iso_AppendDS> aggregate, so that the member’s claim system can be updated with the additional information. Users have the option of adding the Append-DS information to claim reports in the ISO ClaimSearch database by submitting a replacement or update with the additional information. Append-DS is designed to help members: streamline the claims-processing workflow and increase productivity; save time in searching for and retrieving public-records data; and access all available information from ISO ClaimSearch to help facilitate claims processing decisions and reduce claim losses. File Organization The Append-DS aggregate <com.iso_AppendDS> illustrates the layout for public records data returned on a claimant when a SSN missing on a claim is found in public records. It will be returned within the ClaimsParty aggregate that was searched. This aggregate may be repeated up to 10 times showing previous names, addresses, and phone information. Match File Hierarchy <ClaimInvestigationAddRs>… <Policy>…</Policy> <ClaimsOccurrence> <ClaimsParty> (insured)…</ClaimsParty> <ClaimsParty> (claimant) <GeneralPartyInfo>…</GeneralPartyInfo <PersonInfo>…</PersonInfo> <ClaimsInjuredInfo>…<ClaimsInjuredInfo> <com.iso_AppendDS>…</com.iso_AppendDS> </ClaimsParty> … <MatchReportTypeCd>…</MatchReportTypeCd>

Service Information Append-DS is an optional service, and is available at an additional cost. To participate in this service, members must sign an Append-DS Product Supplement to the ClaimSearch agreement. They must also submit claims either using the ISO ClaimSearch Universal Format or the XML format. Customers can choose from the following service options for Append-DS:

Append-DS Service Descriptions Standard Service: Claimants w/o SSNs on all Initial claims (Property, Casualty & Auto coverage)

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Customized Screening Options Option 1: Claimants w/o SSNs on all Initial & Replacement claims (Property, Casualty & Auto coverage)

Option 2: Initial Casualty claims only (claimants w/o SSNs)

Option 3: Initial Casualty claims only (claimants & insured parties w/o SSNs)

Option 4: Initial & Replacement Casualty claims (claimants w/o SSNs)

Option 5: Initial & Replacement Casualty claims (claimants & insured parties w/o SSNs) Further details on this service may be obtained by contacting your ISO ClaimSearch Sales Representative.

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CHILD SUPPORT ENFORCEMENT AGENCY (CSLN/OCSE) REPORTING

The ISO Child Support Enforcement Agency Program (CSEA) cooperates with the Child Support Lien Network (CSLN) in identifying delinquent child support obligors who have filed insurance claims. The CSLN database represents 33 affiliated states. Effective September 15, 2008, ISO has enhanced the CSEA program to add a service offered by the Department of Health and Human Services Office of Child Support Enforcement (OCSE). The Deficit Reduction Act of 2005 allows the OCSE to compare insurer claims data with a federal database of delinquent child support obligors. The OCSE database currently provides access to data from 49 states, the District of Columbia, Puerto Rico, Guam, and the US Virgin Islands. Authorized users include state child support agencies, their authorized vendors, state child support disbursement units, attorneys representing the OCSE member child support agencies, and any court of competent jurisdiction involved in OCSE matters. The CSEA program will allow claims in the ISO ClaimSearch system to also be matched against both the CSLN database and the OCSE database to support enforcement of child support obligations. Insurers, self-insurers and third party administrators can participate in the CSEA program on an individual state or “all states” basis for CSLN, OCSE, or both. When your company participates in the CSEA program in one or more states, currently claimants with bodily injury claims submitted to ISO ClaimSearch by participating companies are checked against the database of delinquent obligors maintained by CSLN and/or OCSE. If there is a match, the system will send the claim to CSLN or OCSE per member participation. If the claim qualifies, CSLN or OCSE will refer the claim to the appropriate state child support enforcement agency. That agency may, at its discretion, place a lien on the settlement of the claim. (No information on CSEA matches is returned directly to the insurer from the ClaimSearch database.) Because of some differences in the states participating in the OCSE and CSLN services and information that each maintains, it may benefit your organization to participate in both services in order to get the most comprehensive information about individuals who fail to pay court-ordered child support. Service Information There is no additional charge for the CSEA (CSLN/OCSE) service. To participate in this service, customers must sign a CSEA Product Supplement to the ISO ClaimSearch agreement. To sign up for any of the CSEA (CSLN/OCSE) program services, please contact ISO ClaimSearch Customer Support at 1-800-888-4476 or send e-mail to info.claimsearch@iso.com. If your company is an Insurer, Self-Insured, or a Third Party Administrator reporting under the Insured’s Membership code, there is no additional programming necessary. File Organization If your company is a Third Party Administrator reporting under the TPA Membership code, you must indicate each party to be searched against the CSLN/OCSE databases by populating each <com.iso_CSLNInd> with “Y” for each ClaimsParty to be searched against the CSLN database, an “O” for each ClaimsParty to be searched against the OCSE database, and a “B” for each ClaimsParty to be searched against both the CSLN, and OCSE database. For the mandatory states in participation with CSLN, no indicator is needed for the claim to be searched against the CSLN database. The mandatory states currently are: NJ, OK, PA, RI, and TX.

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CLAIMDIRECTORSM

ClaimDirectorSM

is an expert supervised system that applies widely used industry fraud indicators to claims submitted to the ISO ClaimSearch

database. ClaimDirector analyzes claim attributes (found on the claim report)

and industry-wide claims histories against fraud indicators. Claim attributes and match information will be weighted to create the score. Data contained in the ISO ClaimSearch database and data provided by the NICB is used to analyze claims scored by ClaimDirector. The data provided by the NICB includes individuals and organizations that have been investigated by the NICB; NICB Prosecutions and Administrative Actions; U.S. Department of Health and Human Services sanctioned medical-providers; American Medical Association data provided by the NICB; exports; impounds; and shipping records. ClaimDirector allows insurance companies to report a claim to the ISO ClaimSearch database and obtain information on cross-line matches. This claim report will be transmitted directly into ISO’s ClaimSearch database and will provide customers with expedient information to assist them in determining the best way to proceed with the adjustment of the claim. ClaimDirector Score ClaimDirector will generate a numeric score that will range from 0 – 999 based on match report information found in ISO ClaimSearch. ClaimDirector delivers the score in the Claims Scoring Information Aggregate (com.iso_ClaimsScoringInfo> and a result report in the Claims Score Report Aggregate <com.iso_ClaimScoreReport>. The result report will provide the company with the basis of the score (e.g. number and type of matches). High scores may indicate a significant number of matches were found in the database and/or the presence of other characteristics that suggest a heightened consideration of the need for further investigation. ClaimDirector currently scores Personal Auto Liability, Commercial Auto Liability, Auto Physical Damage, General Liability, Workers’ Compensation, and Homeowner claims. ClaimDirector scores will be based on matching claims that are within 5 years of the date of the ISO ClaimSearch submission with the exception of Workers’ Comp and VIN matches which will not be restricted by date. ClaimDirector will deliver up to 25 detailed score summaries where output is created. This will allow the system to provide the necessary detailed reports needed by carriers when additional investigation is required. ClaimDirector generates scores when initial or replacement claims are submitted. ClaimDirector does not score on updates or researches. If a claim is sent with the <SuppressMatchInd> and the <com.iso_ClaimDirectorInd>, ClaimDirector takes precedence, and a search is performed, so that the claim can receive a score. Life of Claim Scoring This is defined as the first ClaimDirector Score plus five “re-scores” of that claim. The first ClaimDirector Score can be generated with an Initial Universal Format claim submission or with a Replacement Universal Format claim submission of a claim that has not been previously scored. Claims can be scored up to a total of 6 times during the “life of the claim.” Searches ClaimDirector utilizes the same searches as Universal Format for claimants and insureds with coverage. Under certain conditions, ClaimDirector will search on insureds without coverage for specific lines of business, based on the name and address, SSN, VIN, driver’s license number, license plate number, and phone number. ClaimDirector also provides the number of searchable elements the claim was searched on (maximum 6). In other words, if all searchable elements are provided, the system will find all claims matched in the database. If some searchable elements are missing, some matches could also be missed.

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Customization Options In order to better meet your needs, ClaimDirector is designed to be highly customizable. Your company can choose to customize numerous features within ClaimDirector, such as thresholds (values that behave like filters; they allow the system to return the rule, matching claim, notification, etc. only if the threshold has been exceeded) and weights (the value a rule contributes to the ClaimDirector Score, if the rule fires) to customize scoring for your particular book of business. The thresholds are customizable options that will be determined by each company’s internal guidelines. Customers may customize ClaimDirector by setting these applicable values via an account management function which is available through the web. Customization will be available at the company level. The customization tool will provide customers with the ability to reset the above values to ISO defaults globally and individually. Note – ClaimDirector will be delivered with a set of default values for the features below. Therefore, your company may choose not to customize ClaimDirector or any particular ClaimDirector feature. Matching Claim Threshold Notification Threshold Rule Thresholds Rule Weights Combo Rule Weights Claim Frequency Thresholds Claim Frequency Factors Loss Type Frequency Thresholds Loss Type Frequency Factors Service Information ClaimDirector is an optional service, and is available at an additional cost. To participate in this service, members must sign a ClaimDirector Product Supplement to the ClaimSearch agreement. They must also submit claims using the ISO ClaimSearch Universal Format or the XML format. Please contact your ISO sales representative for further information on this service. If you do not know your sales representative, please contact ISO ClaimSearch at 1-800-888-4476. File Organization – Input File ClaimDirector requires the same basic claim structure and required fields as a basic XML Format claim. Any claim with a ClaimsInjuredInfo, an AutoLossInfo, and/or Investigation Information/Salvage Information Aggregate may be submitted as a ClaimDirector claim. To indicate that the claim being submitted is a ClaimDirector claim, the ClaimDirector <com.iso_ClaimDirectorInd> must be populated with a “1.”

<ClaimInvestigationAddRq>

…

<Policy>……</Policy>

<ClaimsOccurrence>…</ClaimsOccurrence>

<com.iso_ClaimDirectorInd>1</com.iso_ClaimDirectorInd>

</ClaimInvestigationAddRq>

Your company may also wish to do additional programming for: ClaimDirector Important Optional Fields – These are fields that are non-required but searchable and/or

beneficial when performing searches for prior claims histories and also for scoring claims. Please see Customer Package – Programming Documentation for a list of important fields when submitting ClaimDirector claims.

Life of Claim Scoring (LCS) – Your Company may wish to do additional programming for the LCS feature, to determine when to trigger a ClaimDirector score request, in order to best utilize the total scores maximum over the life of the claim.

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Match Report (Output File) The return file will look the same as described in the XML Structure – Match Reports section of this document, except additional aggregates may be sent. If the ClaimDirector Indicator <com.iso_ClaimDirectorInd> is set to “1” on the input, the ClaimDirector Indicator and the Claims Scoring Information aggregate will be returned in your March Report. Within the Claim Scoring Information aggregate, the Claims Handling Characteristics, ClaimDirector Rules, and Claims Score Report aggregates are returned if you request to be set up for them by ISO ClaimSearch. Each of these three aggregates may be repeated multiple times. The Match Report will contain a score at the Claim level, in the initial claim.

<ClaimInvestigationAddRs>

<RqUID>…</RqUID>

<TransactionRequestDt>…</TransactionRequestDt>

<CurCd>…</CurCd>

<CodeList>……. </CodeList>

<MsgStatus>…… </MsgStatus>

<Policy>……</Policy>

…..

<MatchReportTypeCd>…. </MatchReportTypeCd>

<com.iso_ClaimDirectorInd>1</com.iso_ClaimDirectorInd>

<com.iso_ClaimsScoringInfo>

….

<com.iso_ClaimsHandlingCharacteristics>.... </com.iso_ClaimsHandlingCharacteristics>

<com.iso_ClaimDirectorRules>.... </com.iso_ ClaimDirectorRules>

<com.iso_ClaimsScoreReport>.... </com.iso_ ClaimScoreReport>

</com.iso_ClaimsScoringInfo>

<MatchInfo>… </MatchInfo>

<MatchDetails> … </MatchDetails>

….

</ClaimInvestigationAddRs>

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MARINE INDEX BUREAU CLAIMS

The Marine Index Bureau has served the US marine industry since 1937 as the central clearinghouse of bodily injury claims by maritime-industry personnel. The Marine Index Bureau has also been the industry’s repository on hull and machinery-loss information for commercial fishing vessels. ISO ClaimSearch has incorporated into its system the data formerly administered and maintained by the Marine Index Bureau. Members of the Marine Index Bureau will have the ability to add marine claims and obtain cross-line searches including marine and casualty losses. Claims submitted to the Marine Index Bureau involve Longshore, Harborworkers & Jones Act as well as Protection & Indemnity (P&I) claims. Marine claims are most often associated with liability claims (P&I) or Workers’ Compensation. For reporting marine casualty claims in Universal Format, use policy types: COMR Commercial Ocean Marine for liability claims WCMA Workers’ Compensation Marine for Longshore & Harborworkers’ claims Coverage types and loss types are the same as other liability or WC claims. Although ClaimSearch Casualty fields of information are generally sufficient, there are a few fields that are specific to marine claims: Vessel /Call Number: Vessel information may be considered the location of loss for accidents that occur

while the ship is at sea. For cases involving losses off the vessel, for dockworkers, or other personnel associated with marine industry, but not actually on the ship, an actual location of loss is required. Selection of either vessel or location of loss is required. (ClaimInvestigationAddRq/WorkCompLossInfo/ VesselCallId>

8F Claims: 8F is a section of the Federal Longshore & Harborworkers Act that provides reimbursement for

similar previous injuries against a current injury involving Marine industry personnel. The 8F claim field is a Y/N field and is optional. (ClaimInvestigationAddRq/WorkCompLossInfo/SecondInjuryFundInd)

Passport Number: Passport Number of claimant regardless of issuing country.

(ClaimInvestigationAddRq/ClaimsParty/GeneralPartyInfo/NameInfo/NonTaxIdentity) Occupation/Rating: Rating has been added to the occupation field to identify marine employees.

(ClaimInvestigationAddRq/ClaimsParty/PersonInfo/OccupationDesc) NOTE: WCMA (Workers’ Compensation Marine for Longshore & Harborworkers’ claims) are searched against the entire ClaimSearch database. Searches are not limited to five years. Service Information Companies may opt to be members of the Marine Index Bureau through specific membership agreements. They must also submit claims using the ISO ClaimSearch Universal Format or the XML Format.

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MEDICAID REPORTING SERVICE (MAIS)

ISO ClaimSearch developed the ISO ClaimSearch Medicaid Reporting Service in 2012 in response to the Medicaid reporting and verification requirements in Rhode Island. The Rhode Island Executive Office of Health and Human Services (RI EOHHS) passed Article 11 as part of Title 27, chapter 57.1 — the Medical Assistance Intercept Act. Article 11 requires all insurers that write workers compensation or liability policies in Rhode Island to participate in a data match program called the Medical Assistance Intercept System (MAIS). MAIS recovers and intercepts Medicaid payments issued on behalf of Medicaid recipients if an insurer pays on a claim.

Insurers, self-insurers, and third party administrators can participate in the Medicaid Reporting Service on an individual state-by-state basis or through automatic enrollment as additional states allow ISO’s solution to fulfill regulatory reporting requirements.

When a member company is participating in the Medicaid Reporting Service, casualty claims reported to ISO ClaimSearch are checked against the database of Medicaid recipients maintained by MAIS. If there is a match, the system will send the claim to MAIS per member participation. Information on Medicaid matches is not returned directly to the insurer from ISO ClaimSearch.

There are no additional programming changes for ClaimSearch members to participate in this data match program if members are reporting to ISO ClaimSearch using Universal Format. The system will conduct searches of claimants against Rhode Island’s Medicaid Assistance Intercept System (MAIS) database using name and address, name and date of birth, and Social Security number.

The service will send matching claims to MAIS to verify that:

• the claimant is a Rhode Island Medicaid beneficiary with an open bodily injury claim against the insurer

• Rhode Island Medicaid has made payments related to the accident

• the Medicaid payments are related to the injury in the claim

Once MAIS verifies that the claimant is a Medicaid recipient, MAIS will either issue a “lien” or “no lien” document. If MAIS determines that medical payments have been made in relation to a claim, then the initial document will be a lien notice with the lien amount. Both the lien and no lien document are good for 30 days. After expiration, the insurer or attorney can request an updated document.

Service Information: There is no additional charge for ClaimSearch members to participate in the Medicaid Reporting Service. To participate in this service, customers must sign a Medicaid Reporting Service Product Supplement to the ISO ClaimSearch agreement. For interested participants to sign up for the service, please contact ISO ClaimSearch Customer Support at 1-800-888-4476 or send an e-mail to info.claimsearch@iso.com.

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MEDICARE SECONDARY PAYER REPORTING SERVICE (CMS)

Summary The ISO ClaimSearch Medicare Secondary Payer Reporting Service will help insurers comply with mandatory claim reporting requirements of Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007. The legislation, which will take effect on July 1, 2009, could affect most bodily injury settlements that involve an insurance carrier or self-insurer and a Medicare-eligible claimant/plaintiff. Section 111 of the Act adds new mandatory reporting requirements for all Responsible Reporting Entities (RRE), group health plan arrangements, property casualty and workers compensation insurers, and self-insureds. The legislation requires reporting of bodily injury claims files by Medicare-eligible claimants to the U.S. Department of Health and Human Services Center for Medicare & Medicaid Services (CMS). Service Overview ISO ClaimSearch, in coordination with insurers and the insurance trade associations, worked with CMS to design a comprehensive Medicare Secondary Payer Reporting Service. The service will report Medicare-eligible claimants to CMS on behalf of ISO ClaimSearch Universal Format (or XML Format) reporting specifications and report additional data elements to ISO ClaimSearch as required by CMS. The addition of the new data elements (more than 100 distinct fields) required by CMS will require some programming changes for system-to-system companies. ISO ClaimSearch also offers a web reporting option for companies that can’t capture the additional fields in their systems or don’t have the necessary programming resources for the system changes. Companies will be able to update previously reported claims submitted in Universal or XML Format with the additional CMS-Required information through the ISO ClaimSearch web interface. The ISO ClaimSearch website contains all of the data fields CMS requires, and companies will see an indicator next to the CMS-Required fields. Benefits of the Service The ISO ClaimSearch Medicare Secondary Payer Reporting Service solution is integrated with the ISO ClaimSearch claim reporting process. By reporting through ISO ClaimSearch, companies will realize significant savings and workflow process efficiencies of adding to an existing process. The ISO ClaimSearch Medicare Secondary Payer Reporting Service offers:

Help in identifying Medicare-eligible individuals through an optional monthly query function

Timely quarterly reporting to CMS

A process for notifying customers of the claims CMS rejects and acknowledgements

A process for correcting CMS rejections

Timely warnings when claims with Medicare-eligible claimants are missing CMS-Required fields. Determining Medicare Eligibility through Monthly Query To help companies identify Medicare-eligible claimants, ISO will provide an optional query of the CMS database for each participating RRE. Using CMS software, the ISO ClaimSearch system will query your company’s entire history of claims that qualify for CMS reporting against the database every month. Note: All claims must contain the claimant’s name, Social Security Number (SSN), date of birth, gender, and RRE code (if the group/company/office has more than one RRE code). ISO will post the positive results of the query to the Account Management section of the ISO ClaimSearch website so users can log in to check the Medicare-eligibility of claimants. The system will provide that information in a text file format (to be determined) as well as a Microsoft Excel spreadsheet. It is each company’s responsibility to update claims with the Medicare-eligible indicator to show which claims ISO ClaimSearch should send to CMS.

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Quarterly Claim Reporting Companies will be able to report and update claims using either system-to-system connections to ISO ClaimSearch or the ISO ClaimSearch web reporting application. Customers will need to complete additional fields of information required by CMS including an indicator to notify ISO of the Medicare-eligible claimants. ISO ClaimSearch will automatically forward any Medicare-eligible claimants to CMS on a quarterly basis. The quarterly reports will include the following: Ongoing Responsibility for Medicals (ORM), including no-fault and workers compensation; and Total Payment Obligation to the Claimant (TPOC) for all third party liability cases resulting in “a single settlement, judgment, award, or other payment”. ISO ClaimSearch will determine when to include claims in the quarterly report to CMS as follows: Ongoing no-fault insurance and non-contested workers compensation claims (ORM)

When your company first submits a claim with a Medicare-eligible indicator, ISO ClaimSearch will send the claim to CMS.

When your company updates any fields that CMS designates as “important,” ISO ClaimSearch will send the claim to CMS again as an update.

When your company provides the ORM (Ongoing Responsibility for Medicals) date, ISO ClaimSearch will send a final claim to CMS.

Single payment liability claims (TPOC)

When your company marks the claim as Medicare-eligible and provides the TPOC (Total Payment Obligation to the Claimant) date, ISO ClaimSearch will report the claim to CMS.

Acknowledgement and Rejection Service CMS will provide ISO with a file showing the claims that CMS accepted and rejected. ISO will post the results of that file on the Account Management section of the ISO ClaimSearch website so users can log in to see the rejected claims. ISO will also post the information in a Microsoft Excel spreadsheet for download. ISO will link the acknowledgements and rejections to existing claims in ISO ClaimSearch to help companies locate their claims in the database. Users can update and resubmit the rejected claims to ISO ClaimSearch. The system will resubmit the corrected claim to CMS during the next quarterly reporting period. Screening Service for Missing Data – Warning Indicators When companies mark claimants as Medicare-eligible and send a claim to ISO ClaimSearch, the system will screen the claims to identify missing CMS-Required fields. If fields are missing, ISO ClaimSearch will provide a warning indicator on the outgoing ISO ClaimSearch Response when the company first marks the claim as Medicare-eligible and when the company sends Replacements. Warnings are not provided on Update requests or requests marked with the <SuppressMatchInd> on the ClaimInvestigationAddRq because these Requests do not produce Response. The screening service includes rules for reporting contingent fields. For example, information on the claim representative isn’t required. However, if your company reports a representative, the name, address and phone number are required. CMS Warning Indicators DO NOT prevent the claim from being reported to CMS in the quarterly reporting file. They are for informational purposes only and provide your company the chance to update the claim before the next scheduled CMS quarterly submission period. Service Information Medicare Secondary Payer Reporting Service (CMS) is an optional service, and is available at an additional cost. To participate in this service, customers must sign a CMS Product Supplement to the ClaimSearch Agreement. They must also submit claims using the ISO ClaimSearch Universal Format or the XML Format. Please contact your ISO ClaimSearch sales representative for further information on this service. If you do not know your sales representative, please contact ISO ClaimSearch at 1-800-888-4476 or njsupport@iso.com.

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OFAC COMPLIANCE SOLUTIONS

The Office of Foreign Assets Control (OFAC) of the U.S. Department of Treasury administers and enforces economic and trade sanctions against certain foreign governments, organizations, and individuals. OFAC has compiled a master list of more than 5,000 “specially designated nationals and blocked persons.” U.S. insurance companies and their employees are responsible for screening claims against this master list.

OFAC COMPLIANCE SOLUTIONS ISO currently offers several of OFAC service. The OFAC Lookup is provided as part of the ClaimSearch agreement at no additional charge. To participate in any of the other services below, members must sign an OFAC Product Supplement to the ClaimSearch agreement. Each service details whether the service is provided as part of the standard agreement or at an additional charge. OFAC Lookup This is a web-based search tool available on the ISO ClaimSearch website (https://claimsearch.iso.com). Members can search individual names in one-off searches in order to comply with legal requirements of the U.S. Treasury Department’s Office of Foreign Assets Control (OFAC). It also ensures that an organization does not pay out money to a person or organization involved in terrorism,

international narcotics trafficking, or activities related to the proliferation of weapons of mass destruction catches any individual or organization on the OFAC list early in the life of a claim to permit follow up with

appropriate due diligence research Results of the Lookup are returned in an OFAC Match Report on the website. If there is a match, scores are assigned to indicate the degree of validity. (For example, if the first and last name you enter matches the first and last name on the OFAC list exactly, the score would be 100. If the first name you entered was spelled differently than the listing, but the last name you entered was the same as on the list, you may get a score of 90.) Additional information is also provided in the report such as Associated Names, Date of Birth (DOB), Alternate Date(s) of Birth, Place of Birth (POB), Alternate Place(s) of Birth, etc., to assist in due diligence that the information you are querying on is, in fact, the same individual or organization. Standard OFAC Service ISO’s standard OFAC solution is an optional feature of the ISO ClaimSearch system. There are no additional fields or records that need to be programmed for the OFAC standard service. By signing the Product Supplement, all parties to a claim (insured, claimant and service providers) submitted to the ISO ClaimSearch database in Universal or XML Format are automatically screened against the OFAC Specially Designated Nationals List. Should a match occur, contact person(s) specified in advance are notified by e-mail and directed to the secure ISO ClaimSearch website to view match results. ISO employs a special search algorithm when screening for OFAC matches. It is designed to recognize inverted letters, phonetic and cultural equivalents, and even misspellings. (For example, the submitted name of “Osama Ben Ladin” would trigger a match to the name “Osama Bin Laden.”) There is no additional charge to members reporting claims in either ISO’s Universal or XML Format. There is no additional programming for this service. Premium OFAC Service The Premium OFAC Service is identical to the Standard Service with one exception. A match to the OFAC Specially Designated Nationals List triggers a public records search on the matching name. Public record details are returned online with the OFAC Report; and are of particular value when reviewing information on some of the more common names found in OFAC. There is a charge for Premium Service and customers must sign an OFAC Product Supplement. There is no additional programming for this service.

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OFAC Historical Sweep ISO also offers an historical sweep of claims that members have previously submitted to the ISO ClaimSearch database over a specified period of time. Claims are searched in batch with matches displayed in a secure segment of the ISO ClaimSearch website. A designated contact person is notified of matches via e-mail, with a link provided to the secure ISO ClaimSearch website to view results. There is a charge for OFAC Historical Sweep and customers must sign an OFAC Product Supplement. There is no additional programming for this service. OFAC Enterprisewide Solution ISO provides an enterprise-wide OFAC solution that allows members to submit via FTP an electronic file of individual and business names they want screened against the OFAC List. Files are processed overnight and returned via FTP. Submissions are not limited to claims but may also include policyholders, vendors, marketing lists, job applicants and other entities. There is a charge for OFAC Enterprisewide Solution and customers must sign an OFAC Product Supplement. OFAC Enterprisewide has its own file format for the submission of names. Please contact your ISO sales representative for further information on this service. If you do not know your sales representative, please contact ISO ClaimSearch at 1-800-888-4476 or njsupport@iso.com.

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Additional Services Aggregates

The aggregates that follow are used by the Additional (Standard and Optional) Services listed above. . The description of each confirms which service each applies to.

Append-DS Aggregate <com.iso_AppendDS>

This aggregate is optional and will only be returned if your company is signed up for the Append-DS Optional Service.

Tag Type Usage Length Description

<ADSResponseCd> CodeList Required C-2 This element uses the ADSResponseCd code list.

<GeneralPartyInfo> Aggregate Required

<PersonInfo> Aggregate Required

NHTSA Vehicle Recall Aggregate <com.iso_VehRecall>

This aggregate is optional and will only be returned if a search for vehicle recall information is requested (com.iso_RecallRqInd=1) on the Request file. This aggregate may be repeated up to 10 times.

Tag Type Usage Length Description

@id Identifier Required

ItemRef Identifier Reference

Required Identifies the AutoLossInfo to which the Recall applies.

ClaimsPartyRef Identifier Reference

Required Identifies the ClaimsParty to which the AutoLossInfo applies

<ModelYear> Element Optional C-4 Vehicle Year Searched YYYY

<Manufacturer> Element Optional C-27 Vehicle Make Searched

<Model> Element Optional C-30 Vehicle Model Searched

<com.iso_NHTSAid> Element Optional C-12 NHTSA ID

<com.iso_RecallDt> %Date Optional Recall Date YYYY-MM-DD

<com.iso_Component> Element Optional C-75 The component of the vehicle affected by this recall.

<com.iso_RecallSum> Element Required C-165 If a recall is found, the summary of the recall will be provided. If no recall is found, this field will contain the following message: “A search of the NHTSA database produced no recalls on this vehicle, due to the absence of a recall, or the inability to identify this vehicle in the NHTSA database.”

<com.iso_Consqs> Element Optional C-115 The consequences of the recall.

<com.iso_VehAffected> Element Optional C-9 The potential number of units that may have been affected by the recall.

<com.iso_ProdMfr> Element Optional C-40 The manufacturer of the recalled product.

ClaimDirector Rules Aggregate <com.iso_ClaimDirectorRules>

This aggregate is optional and will only be returned if your company is signed up for the ClaimDirector Optional Service.

Tag Type Usage Length Description

<com.iso_RuleCd> Element Extension

Required C-4 Rule Number (provided by ISO ClaimSearch)

<com.iso_RuleTypeCd> Element Extension

Required C-1 S=Single, C=Combo

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ClaimDirector Rules Aggregate <com.iso_ClaimDirectorRules> (cont.)

<com.iso_RuleWeight> Element Extension

Required C-4 Three digit number and sign if a negative number (ex: -050)

<com.iso_RuleDesc> Element Extension

Required C-475 Text Description

Claims Handling Characteristics Aggregate <com.iso_ClaimsHandlingCharacteristics>

This aggregate is optional and will only be returned if your company is signed up for the ClaimDirector Optional Service.

Tag Type Usage Length Description

<com.iso_CharacteristicCd> Code List Required C-4 Please contact ISO ClaimSearch for a current list of IDs.

<com.iso_CharacteristicText> Element Extension

Required C-475 Text of the Claim Handling Characteristic

Claims Party Scored Match Aggregate <com.iso_ScoredMatch>

This aggregate contains detailed information on a scored match for the ClaimDirector Optional Service.

Tag Type Usage Length Description

<com.iso_MatchScoreRank> Element Extension

Required C-2 Places ClaimDirector Scored Matches in order of their score.

<AgencyId> Aggregate Required C-11 AgencyId used indicate ISO’s File Number of this claim

<LossDt> Date Required C-10 The Date of Loss of the match YYYY-MM-DD

<CoverageCd> Code List Required C-4 See CoverageCd code list and Appendix B

<LossCauseCd> Code List Required C-4 See LossTypeCd code list and Appendix B

<com.iso_MatchScore> Element Extension

Required C-3 Score.

Claims Score Report Aggregate <com.iso_ClaimScoreReport>

This aggregate is optional and will only be returned if your company is signed up for the ClaimDirector Optional Service.

Tag Type Usage Length Description

<com.iso_RawScore> Element Extension

Required C-3 Raw score for this claims party.

<com.iso_AdjustedScore>

Element Extension

Required C-3 Adjusted score for this claims party that contributed to the total ClaimDirector Score

<NumMatches> Element Extension

Required C-2 Number of matching claims

<com.iso_SearchableElementCd>

Code List Required Repeating

This element may display up to 6 times – once for each searchable element that was provided on input. Please refer to the SearchableElementCd code list for all elements that may be searched.

<com.iso_ScoredMatch> Aggregate Extension

Required Repeating

Max is 15. If more than 15 matches, an additional 10 matches may be displayed on a second Claim Sore Report Aggregate. Matches with highest scores are displayed first.

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Claims Scoring Information Aggregate <com.iso_ClaimsScoringInfo>

The required fields below will be returned if the <com.iso_ClaimDirectorInd> is set to 1 on input. The optional fields will only be returned if your company is signed up for the ClaimDirector Optional Service.

AGGREGATES FOR CMS SERVICE Although the Medicare Secondary Payer Reporting (CMS) Service is an optional service, many of the elements, or the aggregates that the elements are included on, can be used for regular ISO ClaimSearch reporting as well. Therefore we have chosen to include these in the listings for the core ISO ClaimSearch aggregates. Please see the ClaimsOccurrence, ClaimsParty, ClaimsParty Relationship, com.iso_AddCovInfo, com.iso_CovInfo1, com.iso_CovInfo2, and com.iso_SIUParty in the core ISO ClaimSearch aggregates as well as the com.iso_CMS aggregate below for “CMS specific” reporting elements. Please review all other aggregates for elements that are necessary for both ISO ClaimSearch and CMS reporting.

CMS Warning Aggregate <com.iso_CMS>

This aggregate is a RESPONSE ONLY aggregate and contains the Warning Messages for CMS Fields. ClaimSearch provides the warning for missing CMS required fields. If a field is invalid based on ClaimSearch requirements, we will blank out the field. ClaimSearch is not validating fields based on CMS edits. The warnings are just to provide you with information on missing CMS required fields; it is not a guarantee that CMS will accept your claim once these fields are provided. NOTE - Warnings are only provided on searchable claims. If a claim is marked with the <SuppressMatchInd> on the <ClaimInvestigationAddRq>, no warning will be sent. Likewise, for Update Requests using <com.iso_UpdateInd> 1, 2, 3, 5, or 6, which don’t provide a Successful Response, no Warnings will be provided.

Tag Type Usage Length Description

<com.iso_ClaimDirectorScore>

Element Extension

Required C-3 ClaimDirector Score (000-999).

<com.iso_CharacteristicsFoundInd>

Boolean Extension

Required C-1 Y=Indicates ClaimDirector Claims Handling Characteristics have been found in the claim

<com.iso_ExceededLifeofClaimInd>

Boolean Extension

Required C-1 Y=Indicates claim was not scored because ClaimDirector life of claim exceeded. Each claim may only be scored up to 6 times during the life of the claim.

<com.iso_EmailSentInd> Boolean Extension

Required C-1 Y=ClaimDirector e-mail notification was sent on this submission or on any other previous submission of this claim

<com.iso_NumberTimesScored>

Element Extension

Required C-2 Indicates the number of times a claim was scored

<com.iso_ClaimsHandlingCharacteristics>

Aggregate Extension

Optional Repeating

<com.iso_ClaimDirectorRules>

Aggregate Extension

Optional Repeating

<com.iso_ClaimsScoreReport>

Aggregate Extension

Optional Repeating

Max is 2. This aggregate provides the details of the first 15 matches which were included in the score. If more than 15 matches, this record will be repeated with up to an additional 10 matches. The highest scores are sent first.

Tag Type Usage Length Description

@ItemRef Identifier Reference

Required Intended to refer to the ClaimsInjuredInfo. For companies reporting casualty losses on AutoLossInfo in order to provide the VIN on casualty losses, this may refer to an AutoLossInfo

<com.iso_CMSWarning> Code List Required Repeating

Max 70 Required CMS Fields Missing or Invalid. See Appendix A – CMSWarningCd

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TRANSITIONING FROM UNIVERSAL FORMAT

Generally speaking, the customers that are making the switch between Universal Format and XML Format are doing so along with a larger project of changing the underlying claim system used for all claims processing. We understand that the needs of these customers are different than those who are brand new to automated reporting to ISO ClaimSearch. The customers that are making this type of switch are usually either making the change from a mainframe claim system to a web based claim system that allows for more real-time interactions; or you have chosen a vendor that has already programmed for an XML interface with ISO. This section is intended as a guide for customers keeping the scenarios above in mind. Benefits of Transitioning to XML Platform

Faster processing capabilities via DataPower processing. Universal Format is traditionally an overnight batch process, where XML is 24/7 real-time processing.

“Human Readable” formatting for easier troubleshooting. Improved security features. Schema validation (hierarchy check) is available on customer end of transaction for both Requests and

Responses. Programming Differences between Universal Format and XML Format

For the most part the data submitted in the Universal Format has an equivalent counterpart in the XML Format as they feed into the same programming tables within ISO. The differences that exist are primarily functions of the individual file formats (proprietary vs. industry standard and static vs. dynamic.)

Batch Processing vs. Individual Claim Processing

The largest difference between Universal Format and XML Format is that XML was designed to be transactional based at the individual claim level. Although it is allowed to send up to 25 claims in a single transaction, it is not recommended. If batching of claims is still desired, the best practice is to generate individual claim transactions and hold in a processing queue that is released at set times and then closed again to begin a new “batch.” The XML interface also has 24/7/365 availability, except for a standard maintenance window on Sundays from midnight-4am Eastern. This gives your company the flexibility to offer your users near real-time reports to improve their claims adjusting capabilities. They have the ability to receive their reports while they still have the claim open on their screen reducing the time spent reopening files and recalling what has been done or not done on an individual claim. Universal Format to XML Format Conversions

Since XML is transactional based, it contains a field that Universal Format does not. This field is the Request Unique Identifier <RqUID>. It is found at the <ClaimInvestigationAddRq> level and is used to tie the incoming Response file back to the outgoing Request File, particularly when you have more than one transaction on the same claim on the same day. Given that this field is used to tie the Request and the Response together, it becomes critical for claims that are still within the Automatic Update period or vehicle theft claims that have not yet been recovered to receive their expected system generated reports. It is therefore necessary to undergo a process to update claims that were previously submitted to ISO ClaimSearch in Universal Format with a value for this field as well as change a backend indicator to send out Response in the XML Format rather than Universal Format. ISO ClaimSearch has named this process “UF to XML Conversions”, but in reality you are not converting anything simply updating the values to very specific key fields in the system to transition to a new communication method. For customers making the switch from Universal Format to XML Format, it is imperative to have a conversation with ISO ClaimSearch staff early on in the process to determine the appropriate steps to be taken to convert claims already existing in the ISO system from Universal Format to XML Format. Below is a general outline of

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the steps to be taken, but we have learned that each customer’s situation is unique and needs to be reviewed as such.

UF to XML Conversion Process for Non-Guidewire Customers

1. Contact your ISO ClaimSearch representative (see WHO TO CALL) to let them know that you are working on a project that will change your file transmissions from Universal Format to XML Format. Be prepared to identify a potential “live” date for the new system and how many claims you are expecting to convert.

2. ISO ClaimSearch will work with you to create an overall timeline to specifically meet your project goals within the capabilities of ISO resources.

3. When customers are changing their system so drastically, it is often the case that customers will be also changing other key field information such as Member Code, Policy Numbers, or Claim Numbers. At this step, the Customer will identify the key fields that will be changing with the conversion as well as the criteria for claims to be converted (i.e. by office, by region, by claim number format, date range, open/closed status, etc.)

4. ISO will provide an extract of data that lists key field information for the existing claims on the system based on the criteria provided by the customer as well as a layout for the file.

5. The Customer will update file (retaining original key field values) and append the new key field values even if they remain the same and include an <RqUID> value to be added to the claim. This could be a unique value for each claim or a default value if your system can accept that. The file is sent back to ISO ClaimSearch for processing.

6. ISO ClaimSearch will process the file changing any key fields as necessary, appending the <RqUID> value and changing the source of the claim from Universal Format to XML Format. ISO will provide 2 files when completed. One file contains the listing of successfully processed claims. The other file contains the listing of claims that were rejected from processing for any reason (request would create a duplicate being the most common reason).

7. Customer can then begin to send Replacements/Updates on the successfully processed claims using the XML processes as well as any new claims.

UF to XML Conversion Process for Guidewire Claim Center Customers

For many customers, the value of this field is established by the customer in the pattern that they designate (i.e. claim number-date stamp-time stamp, or some other unique value). For customers that are using the Guidewire ClaimCenter system, the <RqUID> is dictated by the claim system and necessitates an extra step to complete the transition between UF and XML Formats. NOTE – Guidewire Claim Center version 8.0.2 and above users should contact their ISO ClaimSearch Testing Representative for information on the newer DataPower version of our XML application that works with these newer versions of Claim Center.

1. Contact your ISO ClaimSearch representative (see WHO TO CALL) to let them know that you are working on a project that will change your file transmissions from Universal Format to XML Format. Be prepared to identify a potential “live” date for the new system and how many claims you are expecting to convert.

2. ISO ClaimSearch will work with you to create an overall timeline to specifically meet your project goals within the capabilities of ISO resources.

3. When customers are changing their system so drastically, it is often the case that customers will be also changing other key field information such as Member Code, Policy Numbers, or Claim Numbers. At this step, the Customer will identify the key fields that will be changing with the conversion as well as the criteria for claims to be converted (i.e. by office, by region, by claim number format, date range, open/closed status, etc.)

4. ISO will provide an extract of data that lists key field information for the existing claims on the system based on the criteria provided by the customer as well as a layout for the file.

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5. The Customer will update file (retaining original key field values) and append the new key field values even if they remain the same. The file is sent back to ISO ClaimSearch for processing.

6. ISO ClaimSearch will process the file changing any key fields as necessary, and changing the source of the claim from Universal Format to XML Format. ISO will provide 2 files when completed. One file contains the listing of successfully processed claims. The other file contains the listing of claims that were rejected from processing for any reason (request would create a duplicate being the most common reason).

7. Customer will then be required to send through all converted claims that are still in the Automatic Update time frame or is an unrecovered vehicle theft with <ReplacementInd> and <SuppressMatchInd> both set to 1 in order to populate the <RqUID> field with a value specific to the Guidewire ClaimCenter software.

8. Customer can then begin to send Replacements/Updates on the successfully processed claims using the XML processes as well as any new claims.

Testing the Universal Format to XML Format Conversion Process

Many customers have asked to test the processing of the conversion prior to using this on their production claims. This request is completely understandable, but very difficult to accomplish. While ISO ClaimSearch team members are happy to assist in any way we can, the limitations usually exist on the customer’s end of the process. In order to test the process, the first requirement is that there are claims in ISO ClaimSearch’s test database in the Universal Format that correspond to the claims in the Customer’s test database. Unless the Customer has a current method to submit test claims in the Universal Format to the ClaimSearch test database, finding claims that meet this criterion is somewhat of a “needle in a haystack” task. It is often found that test claims have been purged in one or both databases, or that the data on the test claims have been significantly changed on the Customer’s side without an update to the ClaimSearch test database. If the customer is able to provide Universal Format claims to the test database, then the process may be

tested in full before using live production claims. If the customer is not able to provide Universal Format claims to the database, then there is no reliable

method to test this before using live production claims. In this instance, it is ISO’s recommendation to utilize a smaller sampling of production claims for an initial “test” before attempting a conversion en masse in order to determine whether there need to be any adjustments to the process or timing of events. The definition of “smaller sampling” will need to be made on a customer by customer basis as one customer’s “smaller sample” may be another customer’s entire book of business!

Conversion Process Best Practices

ISO ClaimSearch has developed some best practices over the many years of handling these conversions. The best practices are what has worked for the vast majority of customers and should be considered as a “proven” method. However, ISO ClaimSearch also understands that extenuating circumstances may require specific customers to use an alternate timeline. Therefore please speak with your ISO ClaimSearch Testing Representative as early on in the process as possible to determine if your project will be able to work within the guidelines below or will require an alternate timeline. Up to 5,000 records – If the total number of claims that needs to be converted is approx. 5000 or less, then the overall conversion process can be handled 8:01am-1:00pm Eastern Time Monday – Friday. ~5001 – 100,000 records – If the total number of claims falls into this range, then the overall conversion process will need to be handled in the off-business hours of 6:00am-8:00am Eastern Time Monday-Friday. (Note – this is a highly specific 2 hour window between the normal batch processing and the start of the Eastern Time workday.)

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More than 100,000 records – If the total number of claims falls into this range, then the overall conversion process will need to be handled during the weekend hours when it will not interfere with ISO batch processing. This will be Saturday after 6:00am Eastern Time through Sunday before 6:00pm Eastern Time, excluding the Sunday midnight-4am Eastern maintenance window. If your processes are this large, then ISO ClaimSearch may ask you to break this up over multiple weekends. For customers requiring weekend processing, our “best practice” steps are:

1. The Customer stops all claims processing on Thursday night. 2. ISO will provide the extract file (step 4 above) to the Customer on Friday morning after all batch

processing has completed. 3. The Customer will provide the appended file back to ISO before close of business on Friday

afternoon. 4. ISO will schedule a job to run over the weekend. 5. The Customer will be provided with the results files on Monday morning. 6. Non-Guidewire customers can then begin to send/receive claims right away on Monday morning. 7. Guidewire customers will need to complete the “No-Search Replacement” process to add the

RqUID field to their claims then they can begin to send/receive claims.

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ANSWERS TO FREQUENTLY ASKED QUESTIONS

Included in this section are answers to frequently asked questions or important information that is sometimes missed or not considered during the development stages. Every claim must contain a role of CI or IN. Every claim must have at least one coverage record. A

coverage record is a ClaimsInjuredInfo, PropertyLossInfo, or AutoLossInfo Aggregate.

A coverage record is required for these roles: CD, CE, CL, CI, CP.

ClaimsInjuredInfo can only exist for roles CL, CP, CD, CI, IN, ID, IP, IE.

PropertyLossInfo can only exist for roles IN and CI and can exist only one time in a claim.

AutoLossInfo can only exist for roles CL, CP, CD, CI, IN, ID, or IP.

The roles IN, ID, and IP do not require a coverage record, but if they are sent with a casualty coverage record (ClaimsInjuredInfo) and names are marked as individual, then the involved party will be searched.

The PropertyLossInfo/ClaimsSubjectInsuranceInfo does not have coverage reported but instead allows an

entry in the amount of policy, loss estimate, reserve amount for building, contents, loss of use, stock and other categories. The PropertyLossInfo/ItemInfo or PropertyLossInfo/Watercraft aggregates include boats and mobile equipment policies and does require coverage. Use HULL, MOTR and OTPR for the coverage. Use HULL on all boat losses and OTPR on all MOBL losses.

When reporting a loss on a watercraft under a homeowner policy not insured separately (i.e., a rowboat, canoe or kayak), the loss is best reported using the PropertyLossInfo/ClaimsSubjectInsuranceInfo aggregate. It should be reported with a policy type of WCFT for watercraft in the Policy aggregate, using the loss types for Property found in Appendix B. The exposure/loss amount would be reported using either CONTENTS or the OTHER coverage amount in the PropertyLossInfo/ClaimsSubjectInsuranceInfo aggregate.

When reporting a loss on a boat insured separately under an endorsement to a homeowner’s policy or

another policy, the loss is best reported using the PropertyLossInfo/Watercraft aggregate. It should be reported with a policy type of BOAT in the Policy aggregate. PropertyLossInfo/Watercraft is used for boat policies and HIN and model year are required. If you don’t have a HIN or model year, you probably do not have specific coverage on the boat. In the absence of these, an alternative is to use WCFT under PropertyLossInfo/ClaimsSubjectInsuranceInfo (see above).

Snowmobiles and jet skis should be sent as PropertyLossInfo/ItemInfo if possible so we can perform

recoveries (if licensed they should be reported as auto; if not licensed, report as property). Responses will not be generated if claims are reported at the Home Office Level. All claims should be

reported at the office level (last 5 digits of AgencyId should not be 00000). Heavy equipment, if not licensed for road-use, should be marked as inland marine policy types on the

ClaimsOccurrence aggregate and the coverage is reported on the PropertyLossInfo/ItemInfo record. In property, lost or damaged contents pertaining to the structure would be reported under building. Items

and property within the structure would be reported as contents. Use and Occupancy is also known as Time Element - additional living expenses (personal) and business interruption (commercial).

Each ClaimsParty searched can retrieve up to 25 matches. Recoveries (return reason code=V) are sent whenever ISO receives a recovery notification from an agency

other than an insurance company. The notification is only sent once; not if you update or research a claim.

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Cross-line searches are performed against the lines that a company participates in. If a company is not a member of a specific line because they do not write business in that line but are still interested in the cross-line searches, they can obtain the cross-line searches for an additional fee.

For the MAKE codes, a table of valid Makes can be provided. Although ISO would like for you to map your

system to send the correct code, if you cannot, enter the first four characters of the Make of the vehicle. The system will not reject invalid entries but will reject the claim if the make is not provided at all.

For XML reporting, hits will be generated 24 hours a day, 7 days a week except for a few hours a week of

scheduled system outages. You may choose to Update or Replace a claim. Update Requests (com.iso_Update) can be used if you

only want to update a particular part of a claim. Searches are not performed on the Update Requests. Replacements may be sent in addition to or instead of Update Requests. On a Replacement the system essentially finds the original claim reported, deletes it, and adds a new claim in its place, thus it is important to send all parties and information involved in the claim again on the Replacement Request. Searches are performed on Replacements unless the ClaimInvestigationAddRq/ SuppressMatchInd=1.

If a member programs to send automated input but does not want to do the programming to read a

successful response transmission (match), ISO can provide Stylesheet files that can be saved in your system and applied to the response files. This will allow the matches to be viewed, printed and stored in a report format. Failure response transmissions (rejections) cannot be viewed using the Stylesheet.

Searches are performed with the following hierarchy: 1. Name/address/city & state 2. Numeric 3. Specific

line searches. Results are shown in order of the most recent claim appearing first and the oldest appearing last.

Automatic updates in XML format will provide back an echo of your own claim as well as a copy of the

newest matching claim. This is unlike the “legacy” system, which returned all matches on the claim. ICD-9 and ICD-10 Codes are designated by the Centers for Disease Control (CDC) and the World Health

Organization (WHO) and can be found on the public internet. The rejection file will look similar to the match file, but will contain <MsgStatusCd>Rejected</MsgStatusCd>

with a description of the rejection instead of the claim information. If you submit an entire claim as ‘NO SEARCH’ (ClaimInvestigationAddRq/SuppressMatchInd), you will not

receive any Response unless there is an error. If you submit a claim to be searched, but choose to submit an involved party as ‘NO SEARCH’ (ClaimsParty/PartyInvestigationInfo/SuppressMatchInd), you will receive all aggregates back with that <ClaimsParty> listed as ‘NS’ in the raw XML

Dollar amounts should be reported using whole dollars, except for the CMS fields on the

<com.iso_CovInfo1> aggregate which should contain dollars and cents. There can be up to 5 errors per involved party, but a limit of 8 errors per claim, returned in a Rejection

Response. If 8 errors are returned, the entire Request should be reviewed as more errors may exist on the claim.

When reporting Claim Number (ClaimsOccurrence/ ItemIdInfo/ InsurerId) and Policy Numbers (Policy/

PolicyNumber), please do not include any spaces, dashes or other special characters. As part of the processing of claims, spaces, dashes, and special characters will be removed when the claim is added to the ISO ClaimSearch database.

Update Requests using UpdateInds 1, 2, 3, 5, or 6 DO NOT Generate a Response, nor do Requests with

the <SuppressMatchInd> set to “1” on the ClaimsOccurrence. These Requests will only receive the ClaimInvestigationAddRs if there is an XML Data Error.

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APPENDIX A – CODE LISTS

This section contains all the codes needed for an XML submission to ISO ClaimSearch. The code lists are maintained by ISO and correspond to codes used in Universal Format version 5.5, unless otherwise noted. Please note that if the codes required for XML ISO ClaimSearch are not part of the ACORD specification (i.e. it is an ISO-specific code list), ACORD requires the inclusion of an idref (“codelistref”) to a <CodeList>. The <CodeList> aggregate will be used to describe the name and owner of the code list you are using. As an example, in submission to ISO ClaimSearch, you would use the ISO ClaimsPartyRoleCd list instead of the ACORD Role code list and would set a “codelistref” on that element to the <CodeList> as follows: <ClaimsPartyRoleCd codelistref="ABC123 ">CL</ClaimsPartyRoleCd>

<CodeList id="ABC123"> <CodeListName>ClaimsPartyRoleCd</CodeListName> <CodeListOwnerCd>ISOUS</CodeListOwnerCd>

</CodeList> AdditionalMatchCd

HIN – Hull Identification Number SSN – Social Security Number License – License Plate Number VIN – Vehicle Identification Number Phone – Phone Number AddressType (ACORD)

Note - Only used in Policy/ MiscParty/ GeneralPartyInfo; otherwise not used MailingAddress – Mailing Address PhysicalRisk – Physical Risk Address/Location AirbagStatusCd

D – Deployed I – Intact M – Missing AirbagType (ACORD)

Driver – Driver Only Air Bag Passenger – Passenger side front airbag LeftSide – Left side airbag RightSide – Right side airbag AntiTheftDeviceCd

01 – Alarm 02 – Active Disabling Device 03 – Passive Disabling Device 04 – Electronic Homing Device 05 – VIN Etching on Glass 06 – Combination – Alarm & Disabling Device 07 – Combination – Alarm & Electronic Homing Device 08 – Combination – Alarm & VIN Etching on Glass 09 – Combination – Disabling Device & Electronic Homing Device 10 – Combination – Disabling Device & VIN Etching on Glass 11 – Combination – Electronic Homing Device & VIN Etching on Glass

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ADSResponseCd

00 – Successful ER – Error Occurred NM – No Matches AppraiserActivityTypeCd

A – Appraisal E – Estimate V – Valuation BenefitTypeCd

010 – Fatal 020 – Permanent Total 021 – Permanent Total Supplemental 030 – Permanent Partial Scheduled 040 – Permanent Partial Unscheduled 050 – Temporary Total 051 – Temporary Total Catastrophic 070 – Temporary Partial 080 – Employers Liability 090 – Permanent Partial Disfigurement 240 – Employer Paid 410 – Vocational Rehabilitation Maintenance 500 – Compromised Unspecified 501 – Compromised Medical 510 – Compromised Fatal 520 – Compromised Permanent Total 521 – Compromised Permanent Total Supplemental 524 – Compromised Employer Paid 530 – Compromised Permanent Partial Scheduled 540 – Compromised Permanent Partial Unscheduled 541 – Compromised Vocational Rehabilitation Maintenance 550 – Compromised Temporary Total 551 – Compromised Temporary Total Catastrophic 570 – Compromised Temporary Partial 580 – Compromised Employer Liability 590 – Compromised Permanent Partial Disfigurement BodyPartCd

Head 10 – Multiple Head Injury - Any Combination of Below Parts 11 – Skull 12 – Brain 13 – Ear(s) – Includes: Hearing, Inside Eardrum 14 – Eye(s) – Includes: Optic Nerves, Vision, Eye Lids 15 – Nose – Includes: Nasal Passage, Sinus, Sense of Smell 16 – Teeth 17 – Mouth – Includes: Lips, Tongue, Throat, Taste 18 – Soft Tissue 19 – Facial Bones – Includes: Jaw Neck 20 – Multiple Neck Injuries – Any Combination of Below Parts

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21 – Vertebrae – Includes: Spinal Column Bone, “Cervical Segment” 22 – Disc – Includes: Spinal Column Cartilage, “Cervical Segment” 23 – Spinal Cord – Includes: Nerve Tissue, “Cervical Segment” 24 – Larynx – Includes: Cartilage and Vocal Cords 25 – Soft Tissue – Other Than Larynx or Trachea 26 – Trachea Upper Extremities 30 – Multiple Upper Extremities – Any Combination of Below Parts, Excluding Hands and Wrists Combined 31 – Upper Arm – Humerus and Corresponding Muscles, Excluding Clavicle and Scapula 32 – Elbow – Radial Head 33 – Lower Arm – Fore Arm - Radius, Ulna and Corresponding Muscles 34 – Wrist – Carpals and Corresponding Muscles 35 – Hand – Metacarpals and Corresponding Muscles – Excluding Wrist or Fingers 36 – Finger (s) – Other than Thumb and Corresponding Muscles 37 – Thumb 38 – Shoulder (s) – Armpit, Rotator Cuff, Trapezius, Clavicle, Scapula 39 – Wrist (s) & Hand (s) Trunk 40 – Multiple Trunk – Any Combination of Below Parts 41 – Upper Back Area – (Thoracic Area) Upper Back Muscles, Excluding, Vertebrae, Disc, Spinal Cord 42 – Lower Back Area – (Lumbar Area and Lumbo Sacral) Lower Back Muscles, Excluding Sacrum, Coccyx,

Pelvis, Vertebrae, Disc, Spinal Cord 43 – Disc – Spinal Column Cartilage Other than Cervical Segment 44 – Chest – Including Ribs, Sternum, Soft Tissue 45 – Sacrum and Coccyx – Final Nine Vertebrae-fused 46 – Pelvis 47 – Spinal Cord -– Nerve Tissue Other than Cervical Segment 48 – Internal Organs – Other than Heart and Lungs 49 – Heart 60 – Lungs 61 – Abdomen Including Groin – Excluding Injury to Internal Organs 62 – Buttocks – Soft Tissue 63 – Lumbar & or Sacral Vertebrae (Vertebra NOC Trunk) – Bone Portion of the Spinal Column Lower Extremities 50 – Multiple Lower Extremities – Any Combination of Below Parts 51 – Hip 52 – Upper Leg – Femur and Corresponding Muscles 53 – Knee – Patella 54 – Lower Leg - Tibia, Fibula and Corresponding Muscles 55 – Ankle – Tarsals 56 – Foot – Metatarsals, Heel, Achilles Tendon and Corresponding Muscles – Excluding Ankle or Toes 57 – Toes 58 – Great Toe Multiple Body Parts 64 – Artificial Appliance – Braces, Etc. 65 – Insufficient Info to Properly Identify – Unclassified – Insufficient Information to Identify Part Affected 66 – No Physical Injury – Mental Disorder 90 – Multiple Body Parts (including Body Systems & Body Parts) – Applies When More than One Major Body

Part has been Affected, Such as an Arm and a Leg and Multiple Internal Organs 91 – Body Systems and Multiple Body Systems – Applies to the Functioning of an Entire Body System Has

Been Affected Without Specific Injury to Any Other Part, as in the Case of Poisoning, Corrosive Action, Inflammation, Affecting Internal Organs

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CatastropheCd

A code or identifier assigned by an entity or organization to identify a catastrophe occurrence. In this usage, it is a serial number assigned by Insurance Services Office’s Property Claim Service unit. Please contact ISO for the code list. CauseOfInjuryCd (Sample)

Below is a listing of the overall categories of ICD-9-CM Codes beginning with the letter “E” as published by the CDC and WHO. Each “E code” category is comprised of a range of individual 4 character codes. Many 4 character codes are broken down even further by decimal points for specific conditions (total of 5 digits). A full listing of ICD-9-CM codes (001-999, V codes, and E codes) is available on the public internet. Note – This does not require a codelistref CMS recommends the following websites for ICD-9-CM codes: http://www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/icdguide08.pdf http://www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/ftpicd9.htm e800-e807 Railway accidents e810-e819 Motor vehicle traffic accidents e820-e825 Motor vehicle non-traffic accidents e826-e829 Other road vehicle accidents e830-e838 Water transport accidents e840-e845 Air and space transport accidents e846-e848 Vehicle accidents not elsewhere classifiable e849 Place of occurrence e850-e858 Accidental poisoning by drugs, medicinal substances, and biological e860-e869 Accidental poisoning by other solid and liquid substances, gases, and vapors e870-e876 Misadventures to patients during surgical and medical care e878-e879 Surgical and medical procedures as the cause of abnormal reaction of patient or later

complication, without mention of misadventure at the time of procedure. e880-e888 Accidental falls e890-e899 Accidents caused by fire and flames e900-e909 Accidents due to natural and environmental factors e910-e915 Accidents caused by submersion, suffocation, and foreign bodies e916-e928 Other accidents e929 Late effects of accidental injury e930-e949 Drugs, medicinal and biological substances causing adverse effects in therapeutic use. e950-e959 Suicide and self-inflicted injury e960-e969 Homicide and injury purposely inflicted by other persons e970-e978 Legal intervention e979 Terrorism e980-e989 Injury undetermined whether accidentally or purposely inflicted e990-e999 Injury resulting from operations of war ClaimsPartyRole (ACORD) – does not require a codelistref

Alias – Alias ImpouundAgcy – Impounding Agency Appraiser – Appraiser PortOrigin – Port of Origin DeathMaster – Death Master RecoveringAgency – Recovering Agency Emergency – Emergency Agency SalvageBuyer – Salvage Buyer ImpoundFac – Impounding Facility

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ClaimsPartyRoleCd (See Appendix D for further information on these codes) – requires codelistref

BE – Body Shop Employee LW – Lawyer – Other BL - Billing Company MA – Physician’s Assistant BN – Beneficiary MC – Chiropractor BO – Body Shop Manager MD – Medical Doctor BS – Body Shop ME – Emergency Care Facility CD – Claimant Driver MF – Hospital CE – Claimant Pedestrian MG – Radiologist CI – Both Claimant and Insured MH – Medical Clinic/Hospital (for better data quality CL – Claimant please try to use roles MF, ME or MK instead of MH) CO – Corporate Officer MK – Medical Clinic CP – Claimant Passenger ML – Licensed Vocational/Practical Nurse CT – Contractor MM – Other Medical Personnel EM – Employer MN – Nurse ES – Estate MO – Other Doctor FA – Family MR – Laboratory FM – First Mortgagee MS – Dentist GM – Guardian of Minor MT – Physical Therapist GU - Guardian MX – X-Ray Lab IA – Independent Appraiser MY – Other Medical Provider IB – Agent/Broker MZ – Office Administrator ID – Insured Driver NP – Other Non-Professional IE – Insured Employee OC – Other Claimant II – Independent Adjuster OP – Other Professional IN – Insured OR – Other Representative IO – Other Insurance Personnel OW – Owner IP – Insured Passenger OS – Osteopath IR – Staff Appraiser PA – Public Adjuster IS – Staff Adjuster PH – Pharmacy IY – Insurance Employee PS – Psychologist LC – Claimant Lawyer PT – Partner LI – Insured Lawyer PW – Power of Attorney LM – Law Office Manager SM – Second Mortgagee LO – Law Office TN – Tenant LP – Loss Payee TW – Towing Company LR – Paralegal WT – Witness

ClaimStatusCd

C – Closed SAL – Salvage Pending CWP – Closed W/O Payment SUB – Subrogation Pending O – Open Claim Update Indicators (not a code list; does not need “codelistref”)

1 – Adding a Claims Party 4 – Re-Search a Claim (Or Party on a Claim) 2 – Updating a Claims Party 5 – Changing Key Claim Identifiers 3 – Updating an Amount or Status 6 – Adding a Service Provider

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CMSWarningCd

ClaimSearch provides the warnings for missing CMS required fields. If a field is invalid based on ClaimSearch requirements, we will blank out the field. ClaimSearch is not validating fields based on CMS edits. The warnings are just to provide you with information on missing CMS required fields; it is not a guarantee that CMS will accept your claim once these fields are provided.

01 RRE Code Missing or Invalid

02 TIN Missing or Invalid

03 Site ID Missing or Invalid

04 Injured Party HICN or Injured party SSN is required

05 Injured Party DOB missing or Invalid

09 One or more Injured Party Representative Mailing Address Missing or Invalid

12 One or more Injured Party Representative Zip Code Missing or Invalid

13 One or more Injured Party Representative Phone Missing or Invalid

14 Self-Insured Indicator Missing or Invalid – required for liability & WC claims (required for TPA only)

15 Date of Incident Missing or Invalid

16 State of Venue Missing or Invalid

17 No-Fault Insurance Limit Missing or Invalid

18 ORM Indicator Missing or Invalid

19 TPOC Amount Missing or Invalid

21 ICD-9 Diagnosis Code Missing

22 ICD-10 Diagnosis Code Missing

23 ICD-10 Diagnosis Code 1 Missing or Invalid

24 ICD-10 Diagnosis Code 2 Missing or Invalid

25 ICD-10 Diagnosis Code 3 Missing or Invalid

26 ICD-10 Diagnosis Code 4 Missing or Invalid

27 ICD-10 Diagnosis Code 5 Missing or Invalid

28 ICD-10 Diagnosis Code 6 Missing or Invalid

29 ICD-10 Diagnosis Code 7 Missing or Invalid

30 ICD-10 Diagnosis Code 8 Missing or Invalid

31 ICD-10 Diagnosis Code 9 Missing or Invalid

32 ICD-10 Diagnosis Code 10 Missing or Invalid

33 ICD-10 Diagnosis Code 11 Missing or Invalid

34 ICD-10 Diagnosis Code 12 Missing or Invalid

35 ICD-10 Diagnosis Code 13 Missing or Invalid

36 ICD-10 Diagnosis Code 14 Missing or Invalid

37 ICD-10 Diagnosis Code 15 Missing or Invalid

38 ICD-10 Diagnosis Code 16 Missing or Invalid

39 ICD-10 Diagnosis Code 17 Missing or Invalid

40 ICD-10 Diagnosis Code 18 Missing or Invalid

41 ICD-10 Diagnosis Code 19 Missing or Invalid

44 TPOC Date 1 must be greater than the CMS Date of Incident

45 TPOC Date 2 must be greater than the CMS Date of Incident

46 TPOC Date 3 must be greater than the CMS Date of Incident

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47 TPOC Date 4 must be greater than the CMS Date of Incident

48 TPOC Date 5 must be greater than the CMS Date of Incident

49 Total of all TPOC amounts is below dollar threshold

50 ICD-9 Diagnosis Code 1 is Invalid

51 ICD-9 Diagnosis Code 2 is Invalid

52 ICD-9 Diagnosis Code 3 is Invalid

53 ICD-9 Diagnosis Code 4 is Invalid

54 ICD-9 Diagnosis Code 5 is Invalid

55 ICD-9 Diagnosis Code 6 is Invalid

56 ICD-9 Diagnosis Code 7 is Invalid

57 ICD-9 Diagnosis Code 8 is Invalid

58 ICD-9 Diagnosis Code 9 is Invalid

59 ICD-9 Diagnosis Code 10 is Invalid

60 ICD-9 Diagnosis Code 11 is Invalid

61 ICD-9 Diagnosis Code 12 is Invalid

62 ICD-9 Diagnosis Code 13 is Invalid

63 ICD-9 Diagnosis Code 14 is Invalid

64 ICD-9 Diagnosis Code 15 is Invalid

65 ICD-9 Diagnosis Code 16 is Invalid

66 ICD-9 Diagnosis Code 17 is Invalid

67 ICD-9 Diagnosis Code 18 is Invalid

68 ICD-9 Diagnosis Code 19 is Invalid

69 TPOC claim has ORM Indicator = Y. Change to N. If needed, add ORM coverage/loss with ORM = Y

70 ORM claim was entered with ORM Indicator = N. Claim will not be sent to CMS until ORM indicator = Y or until TPOC Date is entered.

71 No fault limit exceeds $99,999,999.99

72 Total of TPOC amounts exceeds $99,999,999.99

73 TPOC amount is sent but TPOC date is missing

74 CMS recommends not using ICD-9 code 9999; claimants may be denied benefits if this code is used.

75 CMS recommends not using ICD-9 code 9599; claimants may be denied benefits if this code is used.

76 NOINJ in ICD-9 or COI field is invalid for WC and No-Fault claims; only valid for liability.

77 NOINJ in the ICD-9 or COI fields can only be reported on claims with the ORM indicator = NO.

78 ICD9-1 and COI are reported as NOINJ; all other ICD9 fields must be blank.

79 NOINJ is only valid for ICD9-1 field; cannot be reported in ICD9-2 through ICD9-19 fields.

80 COI code is NOINJ; ICD9-1 must also be reported as NOINJ.

81 ICD9-1 is NOINJ; COI code must also be reported as NOINJ.

82 Exhaust Date for Dollar Limit should be equal to the ORM Termination Date

CommunicationUseCd (ACORD)

Business – Business Home – Home CoverageCd

Please see Appendix B of this guide – Policy, Coverage, and Loss Types for the entire code list.

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CountryCd (no codelistref required)

For any country besides US or Canada, leave the state field blank and report the country code in the country field. AF AFGHANISTAN LR LIBERIA

AL ALBANIA LY LIBYAN ARAB JAMAHIRIYA

DZ ALGERIA LI LIECHTENSTEIN

AS AMERICAN SAMOA LT LITHUANIA

AD ANDORRA LU LUXEMBOURG

AO ANGOLA MO MACAU

AI ANGUILLA MK MACEDONIA, THE FORMER YUGOSLAV REBUBLIC OF

AQ ANTARCTICA MG MADAGASCAR

AG ANTIGUA AND BARBUDA MW MALAWI

AR ARGENTINA MY MALAYSIA

AM ARMENIA MV MALDIVES

AW ARUBA ML MALI

AU AUSTRALIA MT MALTA

AT AUSTRIA MH MARSHALL ISLANDS

AZ AZERBAIJAN MQ MARTINIQUE

BS BAHAMAS MR MAURITANIA

BH BAHRAIN MU MAURITIUS

BD BANGLADESH YT MAYOTTE

BB BARBADOS MX MEXICO

BY BELARUS FM MICRONESIA, FEDERATED STATES OF

BE BELGIUM MD MOLDOVA, REPUBLIC OF

BZ BELIZE MC MONACO

BJ BENIN MN MONGOLIA

BM BERMUDA MS MONTSERRAT

BT BHUTAN MA MOROCCO

BO BOLIVIA MZ MOZAMBIQUE

BA BOSNIA AND HERZEGOVINA MM MYANMAR

BW BOTSWANA NA NAMIBIA

BV BOUVET ISLAND NR NAURU

BR BRAZIL NP NEPAL

IO BRITISH INDIAN OCEAN TERRITORY

NL NETHERLANDS

BN BRUNEI DARUSSALAM AN NETHERLANDS ANTILLES

BG BULGARIA NC NEW CALEDONIA

BF BURKINA FASO NZ NEW ZEALAND

BI BURUNDI NI NICARAGUA

KH CAMBODIA NE NIGER

CM CAMEROON NG NIGERIA

CA CANADA NU NIUE

CV CAPE VERDE NF NORFOLK ISLAND

KY CAYMAN ISLANDS NO NORWAY

CF CENTRAL AFRICAN REPUBLIC OM OMAN

TD CHAD PK PAKISTAN

CL CHILE PW PALAU

CN CHINA PS PALESTINIAN TERRITORY, OCCUPIED

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CX CHRISTMAS ISLAND PA PANAMA

CC COCOS (KEELING) ISLANDS PG PAPUA NEW GUINEA

CO COLOMBIA PY PARAGUAY

KM COMOROS PE PERU

CG CONGO PH PHILIPPINES

CD CONGO, THE DEMOCRATIC REPUBLIC OF THE

PN PITCAIRN

CK COOK ISLANDS PL POLAND

CR COSTA RICA PT PORTUGAL

CI COTE D'IVOIRE PR PUERTO RICO

HR CROATIA QA QATAR

CU CUBA RE REUNION

CY CYPRUS RO ROMANIA

CZ CZECH REPUBLIC RU RUSSIAN FEDERATION

DK DENMARK RW RWANDA

DJ DJIBOUTI SH SAINT HELENA

DM DOMINICA KN SAINT KITTS AND NEVIS

DO DOMINICAN REPUBLIC LC SAINT LUCIA

TP EAST TIMOR PM SAINT PIERRE AND MIQUELON

EC ECUADOR VC SAINT VINCENT & THE GRENADINES

EG EGYPT WS SAMOA

SV EL SALVADOR SM SAN MARINO

GQ EQUATORIAL GUINEA ST SAO TOME AND PRINCIPE

ER ERITREA SA SAUDI ARABIA

EE ESTONIA SN SENEGAL

ET ETHIOPIA SC SEYCHELLES

FK FALKLAND ISLANDS (MALVINAS) SL SIERRA LEONE

FO FAROE ISLANDS SG SINGAPORE

FJ FIJI SK SLOVAKIA

FI FINLAND SI SLOVENIA

FR FRANCE SB SOLOMON ISLANDS

GF FRENCH GUIANA SO SOMALIA

PF FRENCH POLYNESIA ZA SOUTH AFRICA

TF FRENCH SOUTHERN TERRITORIES GS SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS

GA GABON ES SPAIN

GM GAMBIA LK SRI LANKA

GE GEORGIA SD SUDAN

DE GERMANY SR SURINAME

GH GHANA SJ SVALBARD AND JAN MAYEN

GI GIBRALTAR SZ SWAZILAND

GR GREECE SE SWEDEN

GL GREENLAND CH SWITZERLAND

GD GRENADA SY SYRIAN ARAB REPUBLIC

GP GUADELOUPE TW TAIWAN, PROVINCE OF CHINA

GT GUATEMALA TJ TAJIKISTAN

GN GUINEA TZ TANZANIA, UNITED REPUBLIC OF

GW GUINEA BISSAU TH THAILAND

GY GUYANA TG TOGO

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HT HAITI TK TOKELAU

HM HEARD ISLAND & MCDONALD ISLANDS TO TONGA

VA HOLY SEE (VATICAN CITY STATE) TT TRINIDAD AND TOBAGO

HN HONDURAS TN TUNISIA

HK HONG KONG TR TURKEY

HU HUNGARY TM TURKMENISTAN

IS ICELAND TC TURKS AND CAICOS ISLANDS

IN INDIA TV TUVALU

ID INDONESIA UG UGANDA

IR IRAN, ISLAMIC REPUBLIC OF UA UKRAINE

IQ IRAQ AE UNITED ARAB EMIRATES

IE IRELAND GB UNITED KINGDOM

IL ISRAEL US UNITED STATES

IT ITALY UM U.S.A. MINOR OUTLYING ISLANDS

JM JAMAICA UY URUGUAY

JP JAPAN UZ UZBEKISTAN

JO JORDAN VU VANUATU

KZ KAZAKSTAN VATICAN CITY STATE (see HOLY SEE)

KE KENYA VE VENEZUELA

KI KIRIBATI VN VIET NAM

KP KOREA, DEMOCRATIC PEOPLE'S REPUBLIC OF

VG VIRGIN ISLANDS, BRITISH

KR KOREA, REPUBLIC OF WF WALLIS AND FUTUNA

KW KUWAIT EH WESTERN SAHARA

KG KYRGYZSTAN YE YEMEN

LA LAO PEOPLE'S DEMOCRATIC REPUBLIC

YU YUGOSLAVIA

LV LATVIA ZAIRE (see CONGO)

LB LEBANON ZM ZAMBIA

LS LESOTHO ZW ZIMBABWE

CPT Code (Sample)

Below is a sample of CPT codes. The CPT codes will be reported by the medical provider. A full listing of CPT codes is available from the American Medical Association (AMA) on the public internet. 16025 – Dressings and/or debridement, medium 16030 – Dressings and/or debridement, large 20526 – Corticosteroids 20552 – Trigger Point Injections 20600 – Joint Aspiration 29065 – Application, Cast; shoulder to hand (long arm) 29075 – Application, Cast; elbow to finger (short arm) 29105 – Application of long arm splint (shoulder to hand) 29125 – Application of short arm splint (forearm to hand); static 29130 – Application of finger splint; static Driver’s License Class Codes

DO Non-Commercial Class – Driver/Operator

DJ Non-Commercial Class – Junior License

MC Non-Commercial Class – Motor Cycle

CA Commercial/CDL Class A Truck – Any combination of vehicles (i.e. cab, trailer) with a GVWR (Gross Vehicle Weight Rating) of 26,001 or more pounds (11,793 kg) provided the GVWR of any vehicle(s) being towed is in excess of 10,000 pounds (4536 kg).

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CB Commercial/CDL Class B Truck – Any single vehicle (i.e. cab, trailer) with a GVWR (Gross Vehicle Weight Rating) of 26,001 or more pounds (11,793 kg), or any such vehicle towing a vehicle not in excess of 10,000 pounds (4536 kg) GVWR.

CC Commercial/CDL Class C Truck – Any single vehicle, or combination of vehicles, that does not meet the definition of Class A or Class B, but is either designed to transport 16 or more passengers, including the driver, or is placarded for hazardous materials.

TL Commercial Class – Taxi and Livery

DriverRelationshipToOwnerCd

CH – Child PG – Parent/Guardian EM – Employee PH – Policyholder NO – No-Operator SI – Sibling NR – Non-Related SP – Spouse OR – Other Related UN – Unknown EmploymentStatusCd

AD – Apprenticeship Full Time PT – Part Time Employee AP – Apprenticeship Part Time PW – Piece Worker DS – Disabled RT – Retired FT – Full Time SL – Seasonal NE – Unemployed/Not Employed VO – Volunteer OS – On Strike ZZ – Other Event (ACORD)

Death – Date of death Export – Date that an item was exported Impound – Date that an item was impounded Shipping – Date an item was shipped. This date is provided by the manufacturer.

SuitFiled – The date on which legal action was filed. Theft – Date on which an item was stolen. EventCd

AttorneyDisclosure – Date the employee or beneficiary first secured legal representation EmployerNotice - Date the loss was reported to the employer. Retirement – Date of retirement from this employer. Strike – First date of employee strike Terminated – Date of termination or lay off from this employer. Gender (ACORD)

F – Female M – Male HullMaterialTypeCd

ML – metal PL – plastic OT – other WD – wood ItemDefinition (ACORD)

MoblEquip – Mobile Equipment Watercraft – Watercraft ICDDiagnosticCd (Sample)

The ICD-9 Codes will be reported by the medical provider. Below is a listing of the overall categories of ICD-9 Codes as published by the CDC and WHO. Each category is comprised of a range of individual 3 digit codes. Many 3 digit codes are broken down even further by decimal points for specific conditions (total of 5 digits). A full listing of ICD-9 Codes (001-999, V codes and E codes) is available on the public internet.

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CMS recommends the following websites for ICD-9 Codes: http://www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/icdguide08.pdf http://www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/ftpicd9.htm 001-139 – Infectious and parasitic diseases 140-239 – Neoplasms 240-279 – Endocrine, nutritional and metabolic diseases, and immunity disorders 280-289 – Diseases of the blood and blood forming organs 290-319 – Mental disorders 320-359 – Diseases of the nervous system 360-389 – Diseases of the sense organs 390-459 – Diseases of the circulatory system 460-519 – Diseases of the respiratory system 520-579 – Diseases of the digestive system 580-629 – Diseases of the genitourinary system 630-676 – Complications of pregnancy, childbirth, and the puerperium 680-709 – Diseases of the skin and subcutaneous tissue 710-739 – Diseases of the musculoskeletal system and connective tissue 740-759 – Congenital anomalies 760-779 – Certain conditions originating in the perinatal period 780-799 – Symptoms, signs and ill-defined conditions 800-999 – Injury and poisoning KeyReasonCd

01 – Prior SIU Involvement 02 – Professional Discipline/Sanctions (AMA, etc) 03 – Prior Claims History 04 – 30-day Pre/post Policy Inception/Cancellation 05 – Invalid SSN 06 – Death master file hit on SSN 07 – Delayed Report 08 – Appearance of NICB Forewarn Notice 09 – Mail Drop exists on insured, claimant or searchable service provider address 10 – Undocumented loss (no police/incident reports) 11 – Date of hire/termination to date of loss (WC) 12 – Day of loss; Monday or Friday; day after a holiday 13 – Property loss location different than insured’s address 14 – Prior salvage 15 – VIN failed edit LicensePlateTypeCd

AM – Ambulance MF – Manufacturer AT – ATV ML – Military Vehicle – Canada AR – Amateur Radio/CB Operator MR – Armed Forces Reservist AQ – Antique PR – Press AP – Apportioned PF – Professions BU – Bus MC – Motorcycle CI – City Owned / Municipal Vehicle MD – Dealer CO – Commercial MV – Military Vehicle – USA CC – Consular Corps NG – National Guard Member CL – Collegiate OB – Omnibus CM – Commemorative OR – Organized (e.g. Scouts, K of C) CN – Conservation PC – Passenger Car CU – County Owned PE – Personalized / Customized

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DA – Drive Away PS – Professional Sports DB – Dune Buggy PH – Physician DD – Dentist PX – Pharmacist DL – Dealer RE – Reciprocal DP – Diplomatic RV – Rented Vehicle / Trailer DX – Disabled Person SC – Special Purpose Commercial Vehicle (Street DU – Duplicate, Reissue, Replacement Cleaner, Welding, Trucks) DV – Disabled Veteran SN – Snowmobile EX – Exempt ST – State Owned Vehicle FD – Fire Dept SV – School Vehicle FG – Foreign Gov’t TK – Truck FM – Farm Vehicle TL – Trailer HI – Hearing Impaired TM – Temporary IP – International Plate TP – Transporter IT – In Transit TR – Truck – Tractor JJ – Judge / Justice TX – Taxi LE – Legislative US US – US Gov’t Vehicle LF – Law Enforcement VF – VFW LS – Legislative State, Senator ZZ – All Other LOBCd (ACORD)

Unknown – Unknown (Only valid for Update claims or Appraisal Activity Matches, otherwise use PolicyTypeCd list in Appendix B.) LossTypeCd

Please see Appendix B – Policy, Coverage, and Loss Types for the entire code list. MarketTypeCd (for Appraisal Policy Type Code, which is not required for appraisers to report)

I – Individual C – Commercial If value is blank in system, XML will return “Unknown” MatchReasonCd

A – Address is similar NM – No matches found D – Driver license number is identical NS – Not Searched L – License plate number is identical P – Phone number is identical LL – Similar Location of Loss R – Tax identification number is identical N – Name is similar S – Social security number is identical NC – Name Combination V – Vehicle identification number is identical MatchReportTypeCd

I – Initial R – ReSearch P – Replacement S – Automatic Update Q – Impound Update V – Vehicle Recovery MsgErrorCd

DataError – The data did not pass the ISO ClaimSearch field edits due to missing or invalid data. UFError – The claim did not pass the ISO ClaimSearch programming hierarchy edits. MsgStatusCd

Rejected – The claim did not pass the ISO ClaimSearch edits and was not processed. ResponsePending – Transaction has been received and is processing. Success – The claim was processed in the database. NonTaxIdType (ACORD)

Passport – Passport ProfLicense – Professional License Number

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OccupancyTypeCd

U – Under Construction V – Vacant PaymentType (ACORD)

See Appendix E for further clarification. LossResv – This code is used to report the Reserve Amount associated with a casualty loss or an auto loss in

the ClaimInvestigationAddRq/ClaimsPayment/PaymentTypeCd; or the Reserve Amount associated with a property loss in the PropertyLossInfo/ClaimsSubjectInsuranceInfo/ClaimsPayment.

Payment – This code is used to report the Settlement Amount associated with a property loss in the PropertyLossInfo/ClaimsSubjectInsuranceInfo/ClaimsPayment. Note - To enter the Settlement Amount for a casualty loss or an auto loss in the ClaimInvestigationAddRq/ClaimsPayment/PaymentTypeCd do not provide a PaymentTypeCd, only provide the TotalPaymentAmt/Amt elements with the amount shown in whole dollars.

PaymentTypeCd

See Appendix E for further clarification. FCP - This code is used in the ClaimsPayment/PaymentTypeCd and in conjunction with the ClaimsPayment/

PaymentDt element to report the DATE OF THE FIRST CLAIMS PAYMENT – NOT the amount of the first claims payment.

IndemnityPd - This code is used in the ClaimsPayment/PaymentTypeCd to report the Paid Amount for Indemnity associated with a ClaimsInjuredInfo.

MedicalBillsPd - This code is used in the ClaimsPayment/PaymentTypeCd to report the Paid Amount for

Medical Bills associated with a ClaimsInjuredInfo. TotalLossPd - This code is used in the ClaimsPayment/PaymentTypeCd to report the total paid (excl.

expenses) if Personal Injury or Workers’ Compensation claim (associated with a ClaimsInjuredInfo). If it is a Bodily Injury claim, report the settlement amount.

PhoneType (ACORD)

Only one cell phone, fax, or pager per ClaimsParty is stored on the system. No distinction is made between Business and Personal Use.

Cell – Cell Fax – Fax (These are Request only. Fax Numbers cannot be returned on Responses at this time.) Pager – Pager Phone – Phone PointOfImpactCd

1 – Right Front Corner 11 – Left Front Corner 2 – Right Front 12 – Front End 3 – Right Side 13 – Rollover 4 – Right Rear 14 – Unknown 5 – Right Rear Corner 15 – Obvious Total Loss 6 – Rear Center 16 – Non-Collision Damage 7 – Left Rear Corner 25 – Hood 8 – Left Rear 26 – Decklid 9 – Left Side 27 – Roof 10 – Left Front 28 – Undercarriage PolicyTypeCd

Please see Appendix B of this guide – Policy, Coverage, and Loss Types for the entire code list.

PropulsionTypeCd

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IN – Inboard SA – Sail Only SI – Sail & Auxiliary Inboard Power OB – Outboard MP – Other, includes manual SO – Sail & Auxiliary Outboard Power RealEstateTypeCd

C – Commercial I – Industrial O – Other D – Dwelling M – Multi-Dwelling RecoveryClassificationCd

1 – No Apparent Damage 6 – Stripped – Engine & Other 2 – Stripped of Major Parts – Engine 7 – Stripped – Transmission & Other 3 – Stripped – Transmission 8 – Stripped – Engine, Transmission, & Other 4 – Stripped of Major Parts – Other 9 – No major parts missing, but damaged 5 – Stripped – Engine & Transmission RecoveryConditionCd

0 – Unknown A – Stripped & Flood 2 – No Apparent Damage B – Stripped & Vandalized 3 – Stripped C – Wrecked & Burned 4 – Wrecked D – Wrecked & Vandalized 5 – Burned E – Burned & Vandalized 6 – Flood F – Flood & Vandalized 7 – Vandalized 8 – Stripped & Wrecked 9 – Stripped & Burned RecoveryStatusCd (as used in CannedRecoveryCd element)

1 – Your assured has advised that the vehicle has been located. 2 – Police report has been canceled. If your records indicate the theft is still active, please advise us and we will

reinstate the theft. 3 – Vehicle has been located by captioned agency. 4 – Vehicle has been cleared by captioned agency. Risk (ACORD)

BLDG – Building UseOccupancy – Use & Occupancy C – Contents OT – Other Stock – Stock Role (ACORD)

CarrierInsurer – CarrierInsurer

SearchBasisCd (only used for Update Indicator “4” – Research)

C – Entire Claim I – Individual ClaimsParty SearchableElementCd

DriversLicense – Driver’s License PhoneNumber – Phone Number FailedVIN – VIN (failed edits) TaxIdentity – SSN LicensePlate – License Plate VIN – Vehicle Identification Number NameAddress – Name/Address SSNValidationCd

I – Invalid V – Issued D – Death Master

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StateProvCd (no codelistref required)

Below is a list of valid state codes for all records. These are to be used for US states and territories and for Canadian provinces in the state field. To report a Canadian Province, report “CA” in the country field as well.

AL ALABAMA NV NEVADA

AK ALASKA NB NEW BRUNSWICK

AB ALBERTA NH NEW HAMPSHIRE

AS AMERICAN SAMOA NJ NEW JERSEY

AZ ARIZONA NM NEW MEXICO

AR ARKANSAS NY NEW YORK

AA ARMY/AIRFORCE/NAVY NF NEWFOUNDLAND

AE ARMY/AIRFORCE/NAVY NL NEWFOUNDLAND AND LABRADOR

AP ARMY/AIRFORCE/NAVY NC NORTH CAROLINA

BC BRITISH COLUMBIA ND NORTH DAKOTA

CA CALIFORNIA MP NORTHERN MARIANA ISLANDS

CO COLORADO NT NORTHWEST TERRITORIES

CT CONNECTICUT NS NOVA SCOTIA

DE DELAWARE NU NUNAVUT

DC DISTRICT OF COLUMBIA OH OHIO

FM FEDERATED STATES OF MICRONESIA OK OKLAHOMA

FL FLORIDA ON ONTARIO

GA GEORGIA OR OREGON

GU GUAM PA PENNSYLVANIA

HI HAWAII PE PRINCE EDWARD ISLAND

ID IDAHO PR PUERTO RICO

IL ILLINOIS PW PALAU

IN INDIANA QC QUEBEC

IA IOWA RI RHODE ISLAND

KS KANSAS SK SASKATCHEWAN

KY KENTUCKY SC SOUTH CAROLINA

LA LOUISIANA SD SOUTH DAKOTA

LB LABRADOR TN TENNESSEE

ME MAINE TX TEXAS

MB MANITOBA US US DEFAULT

MH MARSHALL ISLANDS UT UTAH

MD MARYLAND VT VERMONT

MA MASSACHUSETTS VI VIRGIN ISLANDS

MI MICHIGAN VA VIRGINIA

MN MINNESOTA WA WASHINGTON

MS MISSISSIPPI WV WEST VIRGINIA

MO MISSOURI WI WISCONSIN

MT MONTANA WY WYOMING

NE NEBRASKA YT YUKON TERRITORIES

SubjectInsuranceCd

For reporting Theft of Property under PropertyLossInfo/PropertySchedule Art – Art/Antique Jewelry – Jewelry AudioVisual – Audio/Visual Silverware – Silverware Cash – Cash SportsEquip – Sports Equipment Clothing – Clothing Tools – Tools ComputerEquip – Computer Equipment OfficeEquip – Office Equipment

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Furs – Furs Other – Other Guns – Guns For reporting Mobile Equipment under PropertyLossInfo/ItemInfo/ItemDefinition/ItemTypeCd MoblEquip – Mobile Equipment For reporting multiple engines or outdrives on Boat policies under PropertyLossInfo/Watercraft/ItemDefinition/ ItemTypeCd Engine – Engine Outdrive – Outdrive SumReasonCd

A – Address is Similar P – Phone Number is Identical D – Driver License Number is Identical S – Social Security Number is Identical L – License Plate Number is Identical SI – SIU Involvement LT – Same Loss Type V – Vehicle Identification Number is Identical N – Name is Similar TaxId Type (ACORD)

SSN – Social Security Number TaxIdTypeCd

SSN – Social Security Number TIN – Tax Identification Number TheftLocationCd

C – Commercial O – Off Premises R – Residential Threshold Type (ACORD)

DT – Dollar Amount Threshold VT – Verbal Lawsuit Threshold TINValidationCd

I – Invalid V – Valid TortThresholdTypeCd

01 – Verbal Threshold 02 – Dollar Threshold

VehColorCd

AME – Amethyst DBL – Dark Blue MVE – Mauve YEL – Yellow BGE – Beige DGR – Dark Green ONG – Orange BLK – Black GLD – Gold PLE – Purple BLU – Blue GRN – Green PNK – Pink BRO – Brown GRY – Gray RED – Red BRZ – Bronze LAV – Lavender SIL – Silver/Aluminum CAM – Camouflage LBL – Light Blue TAN – Tan COM – Chrome/Stainless Steel LGR – Light Green TEA – Teal CPR – Copper MAR – Maroon/Burgundy TRQ – Turquoise CRM – Cream/Ivory MULCOL – Multicolored WHI – White VehDispositionCd

D – Damaged S – Total Theft R – Repaired N – No Coverage T – Total Loss O – Other X – Unknown

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VehStyleCd

2D – 2 door automobile HY – Hay baler 2H – Hatchback-2door IN – Incomplete vehicle 2T – Hardtop-2door LB – Lowboy or lowbed 3H – Hatchback-3door LD – Loader 4D – 4 door automobile LF – Lift boom (personnel) 4H – Hatchback-4door LK – Log skidder 4T – Hardtop-4door LL – Carry-all 5D – 5 door LM – Limousine 5H – Hatchback-5door LP – Pole AC – Auto carrier LS – Livestock rack AD – Asphalt distributor LW – Lunch wagon AE – Aerial platform MB – Motorbike AI – Air compressor MC – Motorcycle AM – Ambulance MD – Moped AR – Armored truck MF – Unpublished style of farm equip. BC – Brush chipper MH – Motorized home BD – Bulldozer MK – Minibike BG – Buggy, concrete MO – Mower riding or garden tractor BH – Backhoe MR – Mower-conditioner, grass or hay BK – Backhoe loader MS – Motorscooter BR – Beverage rack MT – Motorcycle BT – Boat MV – Multi-wheel BU – Bus MY – Minicycle CB – Chassis and cab OB – Outboard CE – Unpublished style of const equip. OP – Open body CG – Converter gear OT – Other CH – Coach PK – Pickup CI – Corn picker PL – Pallet CK – Cotton picker PM – Pickup with mounted camper CM – Concrete mixer PR – Prime mover CO – Combine (grain harvester) PV – Paver CP – Coupe RD – Roadster CR – Crane RF – Refrigerated van CT – Camping RH – Retractable hardtop CV – Convertible RO – Roller CZ – Cotton stripper SC – Scraper DE – De-tasseling equipment SD – Sedan DI – Potato digger SE – Semi DP – Dump SH – Shovel DR – Drill, rock SI – Striper DS – Tractor truck-diesel SM – Snowmobile FD – Field chopper SO – Snowblower FL – Forklift SS – Sweeper FR – Flatrack ST – Stake or rack FS – Fertilizer spreader SW – Station wagon FT – Firetruck SY – Sprayer FW – Forward control SZ – Saw GA – Wagon TA – Tree harvester (feller-buncher) GD – Grader TC – Tractor track type GE – Generator TF – Tractor wheel type GG – Garbage or refuse TH – Trencher GL – Glider TL – Trailer – generic GN – Grain TN – Tanker GR – Glassrack TO – Touring car HB – Hatchback / fastback TR – Tractor truck gasoline

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VehStyleCd (cont) HD – Hydraulic dump TT – Tow truck / wrecker HE – Horse UT – Utility HL – Haybale loader VA – Vacuum cleaner part HM – Hammer VC – Vancamper HO – Hopper VN – Van HR – Hearse VT – Vanette HS – House WD – Well driller HT – Hardtop WE – Welder HV – Harvester WN – Wind rower VehTypeCd

AT – All Terrain Vehicle (ATV) MP – Multi Purpose Vehicle BT – Boat PC – Passenger Car CE – Construction Equipment PT – Part FE – Farm Equipment SB – Snowmobile HD – Heavy Duty Truck TK – Truck LT – Light Duty Truck TL – Trailer MC – Motorcycle WaterUnitTypeCd

AI – Airboat RU – Runabout CO – Commercial SA – Sailboat CR – Cruiser UT – Utility HS – Houseboat YA – Yacht HO – Hovercraft YY – Other (jetski, canoe, kayak, johnboat, HY – Hydrofoil rowboat, etc) HR – Hydroplane

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APPENDIX B – POLICY, COVERAGE, AND LOSS TYPES

All claims entered in the ISO ClaimSearch system must be associated with an insurance policy or self-insured retention. The appropriate policy type, the coverage that applies within the policy, and the type of loss associated with the coverage identify the claim as unique. Companies use different nomenclature to identify its policy and loss information. However, companies categorize their claims under policy types or lines of business by varying degrees of specificity. Appendix B provides policy, coverage, and loss type selections for most policy types. An "Other" category is available for policies not included in the table. All claims should be able to be entered into ClaimSearch using one of these Universal Format Policy, Coverage, and Loss types. Appendix B considers multiple policy types, claimants, coverage, and loss types within an accident, provided: Policy and claim numbers remain consistent. Loss is assigned to one policy number, and handled under one file (claim) number. To correctly enter the claim information, enter the policy type and select the most appropriate coverage and loss type included on Appendix B. If the appropriate policy, coverage and/or loss type is not included in Appendix B, an entry of one of the “OTHER” policy, coverage or loss types (e.g., OTCA, OTLB, OTAU) is acceptable. We do recommend, however, that the information be as accurate as possible, that the options be closely reviewed for a selection that describes your claim, and that you use "other" only where "more descriptive coverage and loss type" is not available. Insureds with first-party claims and claimants often have claims with more than one coverage; i.e., PIP, bodily injury; collision and property damage, etc. Appendix B allows multiple coverage and loss types for the same loss. Any combination of selections is allowed, provided it is within the grid for that policy type. For example, an insured suffers an auto collision and sustains an injury in the auto accident. The policy, coverage, and loss type for this claim is:

Policy Type Coverage Loss Type

Vehicle Damage PAPP COLL COLL

Injury to Person PAPP NFLT NFLT

Some companies divide coverages into sub-coverages to respond to statutory requirements or endorsements. While ClaimSearch prefers loss type be limited to one coverage (i.e., NFLT) multiple loss types are allowed provided the same coverage and loss type is not repeated for a single involved party’s casualty or property coverage; or per VIN for a single involved party. Property claims are policy level. There are policy segments (building, contents, loss of use, etc.) where dollar amounts under policy, estimate of loss, reserve and amount paid can be entered to indicate coverage. As there is only one proximate cause of loss in property claims, only one policy type and loss type should be included in your report. We have attempted to include loss types that apply to the great majority of claims. This manual will be updated with contemporary loss types requested by participating companies.

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Reporting Claims to ClaimSearch under Personal Combination Policies

Homeowners’ claims are submitted based on the coverage afforded; first party property and liability-property damage and first and third-party bodily injury. Although automobiles are excluded under Homeowners policies, there exist policies that insure both Homeowners and Auto under a combination contract. These policies are not widely popular, but in the event of a loss that involves property and auto under these policies, we have made accommodations to allow these losses to be reported in XML Format. We have added automobile loss types under property coverage to facilitate reporting of vehicle losses under the combination contract. Examples of these losses include insured vehicles damaged in fire losses at the insured residence, or vandalism of the house and vehicles on the premises. Auto Policies that include collision and/or comprehensive coverage usually exclude non-auto property. However, to respond to these combination policies, we have added property loss types under auto coverage. Again, these losses are not frequent, but we wish to provide sufficient flexibility in XML Format to respond for these losses when they occur. Policy, Coverage and Loss Determinations for Medicare Secondary Payer Section 111 Reporting

Medicare Secondary Payer Section 111 reporting specifies three types of coverage:

No Fault - Terminology adopted that responds for medical payments covered is “Ongoing Responsibility for Medicals (ORM).

Liability - Terminology adopted for these claims is “Total Payment Obligation to the Claimant” (TPOC).

Workers Compensation - Terminology adopted by CMS to respond to these claims is either ORM or TPOC (provided there is a settlement ), subject to conditions, thresholds and procedures found in the Medicare Secondary Payer Section 111 User Guide (various editions), produced by CMS,

As a general rule, claims associated with third party bodily injury claims are considered TPOC claims. Medical Payments under PIP, Med Pay or Workers Compensation medical payments is considered ORM for CMS reporting purposes. Workers Compensation Indemnity carries its own rules, and at the time of this writing is still under discussion as to the status of WC Indemnity, whether settlement s are considered TPOC, or because indemnity settlements are not based on medical payments (handled as ORM), are subject to CMS reporting. Currently, ISO is handling all WC claims as ORM. ISO ClaimSearch provides the ability to submit TPOC information on a WC report, if companies intend to report Workers Compensation Indemnity settlements in this manner. Any TPOC information entered on a WC claim will be sent to CMS at the designated ORM timeframes. Not all Policy, Coverage, and Loss Types available in Appendix A are valid for CMS Reporting purposes. In the Appendix A tables of the Universal Format manual, we have marked Medicare-Eligible Policy/ Coverage/Loss combinations by adding a column named “CMS”. An “O” in this field indicates that it may be used for an “ORM” claim. A “T” in this field indicates that it may be used for a “TPOC” claim. A “W” indicates that it is a Workers Compensation claim and may be ORM or TPOC, per CMS rules. An “X” in this field indicates that it uses ORM required fields and processes as an ORM claim, but will be sent to CMS and show on the CMS Acknowledgement and Error files as a “Plan Type: L”. The purpose of this addition is to act as guidance for programmers who are incorporating the MSP service into their Universal Format system-to-system programming. ISO ClaimSearch utilizes the Universal Format reporting program wherever possible. As participants are required to select policy, coverage and loss for all claims submitted to ClaimSearch, we try to use the same ISO procedures to reduce redundancy and increase efficiency in reporting. There is no need for you to identify these types independently since ISO derives the type for you.

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ClaimsInjuredInfo Combinations - Please use the following policy, coverage, and loss type combinations in conjunction with the ClaimsInjuredInfo aggregate on the “Claimant” ClaimsParty when reporting injury, liability, and damage to 3

rd party property other than vehicle. CMS column – “O” = valid for ORM; “T” = valid

for TPOC; “W” = valid for Work Comp; and “X” = Plan Type L ORM claim. See Policy, Coverage and Loss Determinations for Medicare Secondary Payer Section 111 Reporting for further information.

Commercial Liability

POLICY TYPE COVERAGE TYPE LOSS TYPE CMS

CPMP COMMERCIAL DRCT DIRECTORS & BODI BODILY INJURY T

MULTI PERIL OFFICERS DISC DISCRIMINATION

FALS FALSE ARREST

HARS HARASSMENT

LIAB PROPERTY DAMAGE

LIBL LIBEL

MPRS MALICIOUS PROSECUTION

OTCA OTHER T

OTPI OTHER PERSONAL INJURY

SLND SLANDER

WEVC WRONGFUL EVICTION

WTRM WRONGFUL TERMINATION

EROM ERRORS & BODI BODILY INJURY T

OMISSIONS LIAB PROPERTY DAMAGE

OTCA OTHER T

ERPL EMPLOYERS BODI BODILY INJURY T

DISC DISCRIMINATION

HARS HARASSMENT

LIBL LIBEL

OTCA OTHER T

OTPI OTHER PERSONAL INJURY

SLND SLANDER

WTRM WRONGFUL TERMINATION

LIAB LIABILITY BISF SLIP & FALL T

(includes property damage BODI BODILY INJURY T

and bodily injury) DISC DISCRIMINATION

DOGB DOG BITE T

ENVR ENVIRONMENTAL T

FALS FALSE ARREST

HARS HARASSMENT

LIAB PROPERTY DAMAGE

LIBL LIBEL

MPAY MEDICAL PAYMENTS X

MPRS MALICIOUS PROSECUTION

OTCA OTHER T

OTPI OTHER PERSONAL INJURY T

SLND SLANDER

TRSM TERRORISM

WTRM WRONGFUL TERMINATION

WEVC WRONGFUL EVICTION

MPAY MEDICAL BODI BODILY INJURY O

PAYMENTS MPAY MEDICAL PAYMENTS O

OTLB OTHER LIABILITY BISF SLIP & FALL T

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POLICY TYPE COVERAGE TYPE LOSS TYPE CMS

CPMP COMMERCIAL OTLB OTHER LIABILITY BODI BODILY INJURY T

MULTIPERIL (continued) (continued) DISC DISCRIMINATION

DOGB DOG BITE T

ENVR ENVIRONMENTAL T

FALS FALSE ARREST

HARS HARASSMENT

LIAB PROPERTY DAMAGE

LIBL LIBEL

MPAY MEDICAL PAYMENTS X

MPRS MALICIOUS PROSECUTION

OTCA OTHER T

OTPI OTHER PERSONAL INJURY T

SLND SLANDER

TRSM TERRORISM

WEVC WRONGFUL EVICTION

WTRM WRONGFUL TERMINATION

PINJ PERSONAL BODI BODILY INJURY T

INJURY DISC DISCRIMINATION

FALS FALSE ARREST

HARS HARASSMENT

LIBL LIBEL

MPRS MALICIOUS PROSECUTION

OTCA OTHER T

OTPI OTHER PERSONAL INJURY T

SLND SLANDER

WEVC WRONGFUL EVICTION

WTRM WRONGFUL TERMINATION

POLL POLLUTION BODI BODILY INJURY T

ENVR ENVIRONMENTAL T

LIAB PROPERTY DAMAGE

OTCA OTHER T

TRSM TERRORISM

PROD PRODUCTS & BODI BODILY INJURY T

COMPLETED LIAB PROPERTY DAMAGE

OPERATIONS OTCA OTHER T

PTCI PROTECTION & BODI BODILY INJURY T

INDEMNITY LIAB PROPERTY DAMAGE

OTCA OTHER T

TRSM TERRORISM

CFRM FARMOWNERS LIAB LIABILITY BISF SLIP & FALL T

BODI BODILY INJURY T

DISC DISCRIMINATION

DOGB DOG BITE T

ENVR ENVIRONMENTAL T

FALS FALSE ARREST

HARS HARASSMENT

LIAB PROPERTY DAMAGE

LIBL LIBEL

MPAY MEDICAL PAYMENTS X

MPRS MALICIOUS PROSECUTION

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POLICY TYPE COVERAGE TYPE LOSS TYPE CMS

CFRM FARMOWNERS LIAB LIABILITY OTCA OTHER T

(continued) (continued) OTPI OTHER PERSONAL INJURY T

SLND SLANDER

TRSM TERRORISM

WEVC WRONGFUL EVICTION

WTRM WRONGFUL TERMINATION

MPAY MEDICAL BODI BODILY INJURY O

PAYMENTS MPAY MEDICAL PAYMENTS O

OTLB OTHER LIABILITY BISF SLIP & FALL

BODI BODILY INJURY T

DISC DISCRIMINATION

DOGB DOG BITE

ENVR ENVIRONMENTAL

FALS FALSE ARREST

HARS HARASSMENT

LIAB PROPERTY DAMAGE

LIBL LIBEL

MPRS MALICIOUS PROSECUTION

OTCA OTHER T

OTPI OTHER PERSONAL INJURY

TRSM TERRORISM

WEVC WRONGFUL EVICTION

WTRM WRONGFUL TERMINATION

POLL POLLUTION BODI BODILY INJURY T

ENVR ENVIRONMENTAL

LIAB PROPERTY DAMAGE

OTCA OTHER T

OTPI OTHER PERSONAL INJURY T

PROD PRODUCTS & BODI BODILY INJURY

COMPLETED LIAB LIABILITY

OPERATIONS MPAY MEDICAL PAYMENTS

OTCA OTHER

SLND SLANDER

CCGL GENERAL DRCT DIRECTORS & BODI BODILY INJURY T

LIABILITY OFFICERS DISC DISCRIMINATION

FALS FALSE ARREST

HARS HARASSMENT

LIAB PROPERTY DAMAGE

LIBL LIBEL

MPRS MALICIOUS PROSECUTION

OTCA OTHER T

OTPI OTHER PERSONAL INJURY

SLND SLANDER

WEVC WRONGFUL EVICTION

WTRM WRONGFUL TERMINATION

EROM ERRORS & BODI BODILY INJURY T

OMISSIONS LIAB PROPERTY DAMAGE

OTCA OTHER T

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POLICY TYPE COVERAGE TYPE LOSS TYPE CMS

CCGL GENERAL ERPL EMPLOYERS BODI BODILY INJURY T

LIABILITY (continued) RELATED PRACTICE DISC DISCRIMINATION

HARS HARASSMENT

LIBL LIBEL

OTCA OTHER T

OTPI OTHER PERSONAL INJURY T

SLND SLANDER

WTRM WRONGFUL TERMINATION

LIAB LIABILITY BISF SLIP & FALL T

BODI BODILY INJURY T

DISC DISCRIMINATION

DOGB DOG BITE T

ENVR ENVIRONMENTAL T

FALS FALSE ARREST

HARS HARASSMENT

LIAB PROPERTY DAMAGE

LIBL LIBEL

MPAY MEDICAL PAYMENTS X

MPRS MALICIOUS PROSECUTION

OTCA OTHER T

OTPI OTHER PERSONAL INJURY T

SLND SLANDER

TRSM TERRORISM

WEVC WRONGFUL EVICTION

WTRM WRONGFUL TERMINATION

MPAY MEDICAL BODI BODILY INJURY O

PAYMENTS MPAY MEDICAL PAYMENTS O

OTLB OTHER LIABILITY BISF SLIP & FALL T

BODI BODILY INJURY T

DISC DISCRIMINATION

DOGB DOG BITE T

ENVR ENVIRONMENTAL T

HARS HARASSMENT

FALS FALSE ARREST

LIAB PROPERTY DAMAGE

LIBL LIBEL

MPAY MEDICAL PAYMENTS X

MPRS MALICIOUS PROSECUTION

OTCA OTHER T

SLND SLANDER

TRSM TERRORISM

WEVC WRONGFUL EVICTION

WTRM WRONGFUL TERMINATION

PINJ PERSONAL BODI BODILY INJURY T

INJURY DISC DISCRIMINATION

FALS FALSE ARREST

HARS HARASSMENT

LIBL LIBEL

158

POLICY TYPE COVERAGE TYPE LOSS TYPE CMS

CCGL GENERAL PINJ PERSONAL MPRS MALICIOUS PROSECUTION

LIABILITY (continued) INJURY (continued) OTCA OTHER T

OTPI OTHER PERSONAL INJURY T

SLND SLANDER

WEVC WRONGFUL EVICTION

WTRM WRONGFUL TERMINATION

POLL POLLUTION BODI BODILY INJURY T

ENVR ENVIRONMENTAL T

LIAB PROPERTY DAMAGE

OTCA OTHER T

TRSM TERRORISM

PROD PRODUCTS & BODI BODILY INJURY T

COMPLETED LIAB PROPERTY DAMAGE

OPERATIONS OTCA OTHER T

PLIB PROFESSIONAL DRCT DIRECTORS & BODI BODILY INJURY T

LIABILITY OFFICERS DISC DISCRIMINATION

FALS FALSE ARREST

HARS HARASSMENT

LIAB PROPERTY DAMAGE

LIBL LIBEL

MPRS MALICIOUS PROSECUTION

OTCA OTHER T

OTPI OTHER PERSONAL INJURY

SLND SLANDER

WEVC WRONGFUL EVICTION

WTRM WRONGFUL TERMINATION

EROM ERRORS & BODI BODILY INJURY T

OMISSIONS LIAB PROPERTY DAMAGE

OTCA OTHER T

ERPL EMPLOYERS BODI BODILY INJURY T

DISC DISCRIMINATION

HARS HARASSMENT

LIBL LIBEL

OTCA OTHER T

OTPI OTHER PERSONAL INJURY T

SLND SLANDER

WTRM WRONGFUL TERMINATION

LIAB LIABILITY BISF SLIP & FALL T

BODI BODILY INJURY T

DISC DISCRIMINATION

DOGB DOG BITE T

ENVR ENVIRONMENTAL T

FALS FALSE ARREST

HARS HARASSMENT

LIAB PROPERTY DAMAGE

LIBL LIBEL

MPAY MEDICAL PAYMENTS X

MPRS MALICIOUS PROSECUTION

159

POLICY TYPE COVERAGE TYPE LOSS TYPE CMS

PLIB PROFESSIONAL LIAB LIABILITY (continued) OTCA OTHER T

LIABILITY (continued) OTPI OTHER PERSONAL INJURY T

SLND SLANDER

TRSM TERRORISM

WEVC WRONGFUL EVICTION

WTRM WRONGFUL TERMINATION

MPAY MEDICAL BODI BODILY INJURY O

PAYMENTS MPAY MEDICAL PAYMENTS O

OTLB OTHER LIABILITY BISF SLIP & FALL T

BODI BODILY INJURY T

DISC DISCRIMINATION

DOGB DOG BITE T

ENVR ENVIORNMENTAL T

FALS FALSE ARREST

HARS HARRASSMENT

LIAB PROPERTY DAMAGE

LIBL LIBEL

MPAY MEDICAL PAYMENTS X

MPRS MALICIOUS PROSECUTION

OTCA OTHER T

OTPI OTHER PERSONAL INJURY T

SLND SLANDER

TRSM TERRORISM

WEVC WRONGFUL EVICTION

WTRM WRONGUL TERMINATION

PINJ PERSONAL INJURY BODI BODILY INJURY T

DISC DISCRIMINATION

FALS FALSE ARREST

HARS HARASSMENT

LIBL LIBEL

MPRS MALICIOUS PROSECUTION

OTCA OTHER T

OTPI OTHER PERSONAL INJURY T

SLND SLANDER

WEVC WRONGFUL EVICTION

WTRM WRONGFUL TERMINATION

MMAL MEDICAL OTLB OTHER LIABILITY BISF SLIP & FALL T

MALPRACTICE BODI BODILY INJURY T

DISC DISCRIMINATION

DOGB DOG BITE

ENVR ENVIRONMENTAL

FALS FALSE ARREST

HARS HARASSMENT

LIAB PROPERTY DAMAGE

LIBL LIBEL

MPAY MEDICAL PAYMENTS X

MPRS MALICIOUS PROSECUTION

OTCA OTHER T

SLND SLANDER

160

POLICY TYPE COVERAGE TYPE LOSS TYPE CMS

MMAL MEDICAL OTLB OTHER LIABILITY TRSM TERRORISM

MALPRACTICE (continued) WEVC WRONGFUL EVICTION

(continued) WTRM WRONGFUL TERMINATION

COMR OCEAN LIAB LIABILITY BISF SLIP & FALL T

MARINE BODI BODILY INJURY T

DISC DISCRIMINATION

DOGB DOG BITE T

ENVR ENVIRONMENTAL T

FALS FALSE ARREST

HARS HARASSMENT

LIAB PROPERTY DAMAGE

LIBL LIBEL

MPAY MEDICAL PAYMENTS X

MPRS MALICIOUS PROSECUTION

OTCA OTHER T

OTPI OTHER PERSONAL INJURY T

SLND SLANDER

TRSM TERRORISM

WEVC WRONGFUL EVICTION

WTRM WRONGFUL TERMINATION

OTLB OTHER LIABILITY BISF SLIP & FALL T

BODI BODILY INJURY T

DISC DISCRIMINATION

DOGB DOG BITE T

ENVR ENVIRONMENTAL T

FALS FALSE ARREST

HARS HARASSMENT

LIAB PROPERTY DAMAGE

LIBL LIBEL

MPAY MEDICAL PAYMENTS X

MPRS MALICIOUS PROSECUTION

OTCA OTHER T

SLND SLANDER

TRSM TERRORISM

WEVC WRONGFUL EVICTION

WTRM WRONGFUL TERMINATION

PTCI PROTECTION & BODI BODILY INJURY T

INDEMNITY LIAB PROPERTY DAMAGE

OTCA OTHER T

OLIB OTHER DRCT DIRECTORS & BODI BODILY INJURY T

LIABILITY OFFICERS DISC DISCRIMINATION

FALS FALSE ARREST

HARS HARASSMENT

LIAB PROPERTY DAMAGE

LIBL LIBEL

MPRS MALICIOUS PROSECUTION

OTCA OTHER T

OTPI OTHER PERSONAL INJURY

SLND SLANDER

WEVC WRONGFUL EVICTION

161

POLICY TYPE COVERAGE TYPE LOSS TYPE CMS

OLIB OTHER DRCT DIRECTORS & WTRM WRONGFUL TERMINATION

LIABILITY (cont) OFFICERS (continued) DISC DISCRIMINATION

EROM ERRORS & BODI BODILY INJURY T

OMISSIONS LIAB PROPERTY DAMAGE

OTCA OTHER T

ERPL EMPLOYERS BODI BODILY INJURY T

RELATED PRACTICES DISC DISCRIMINATION

HARS HARASSMENT

LIBL LIBEL

OTCA OTHER T

OTPI OTHER PERSONAL INJURY

SLND SLANDER

WTRM WRONGFUL TERMINATION

LIAB LIABILITY BISF SLIP & FALL T

BODI BODILY INJURY T

DISC DISCRIMINATION

DOGB DOG BITE T

ENVR ENVIRONMENTAL T

FALS FALSE ARREST

HARS HARASSMENT

LIAB PROPERTY DAMAGE

LIBL LIBEL

MPAY MEDICAL PAYMENTS X

MPRS MALICIOUS PROSECUTION

OTCA OTHER T

OTPI OTHER PERSONAL INJURY T

SLND SLANDER

TRSM TERRORISM

WEVC WRONGFUL EVICTION

WTRM WRONGFUL TERMINATION

OTLB OTHER LIABILITY BISF SLIP & FALL T

BODI BODILY INJURY T

DISC DISCRIMINATION

DOGB DOG BITE T

ENVR ENVIRONMENTAL T

FALS FALSE ARREST

HARS HARASSMENT

LIAB PROPERTY DAMAGE

MPAY MEDICAL PAYMENTS X

OTCA OTHER T

OTPI OTHER PERSONAL INJURY T

SLND SLANDER

TRSM TERRORISM

WEVC WRONGFUL EVICTION

WTRM WRONGFUL TERMINATION

PINJ PERSONAL INJURY BODI BODILY INJURY

DISC DISCRIMINATION

FALS FALSE ARREST

HARS HARASSMENT

162

POLICY TYPE COVERAGE TYPE LOSS TYPE CMS

OTLB OTHER PINJ PERSONAL INJURY LIBL LIBEL

LIABILITY (continued) (continued) MPRS MALICIOUS PROSECUTION

OTCA OTHER T

OTPI OTHER PERSONAL INJURY

SLND SLANDER

WEVC WRONGFUL EVICTION

WTRM WRONGFUL TERMINATION

POLL POLLUTION BODI BODILY INJURY T

ENVR ENVIRONMENTAL T

LIAB PROPERTY DAMAGE

OTCA OTHER T

PROD PRODUCTS & BODI BODILY INJURY T

COMPLETED LIAB PROPERTY DAMAGE

OPERATIONS OTCA OTHER T

UMBR UMBRELLA LIAB LIABILITY BISF SLIP & FALL T

BODI BODILY INJURY T

DISC DISCRIMINATION

DOGB DOG BITE T

ENVR ENVIRONMENTAL T

FALS FALSE ARREST

HARS HARASSMENT

LIAB LIABILITY

LIBL LIBEL

MPAY MEDICAL PAYMENTS X

MPRS MALICIOUS PROSECUTION

OTCA OTHER T

OTPI OTHER PERSONAL INJURY T

SLND SLANDER

TRSM TERRORISM

WEVC WRONGFUL EVICTION

WTRM WRONGFUL TERMINATION

OTLB OTHER LIABILITY BISF SLIP & FALL

BODI BODILY INJURY T

DISC DISCRIMINATION

DOGB DOG BITE T

ENVR ENVIRONMENTAL T

FALS FALSE ARREST

HARS HARASSMENT

LIAB LIABILITY

LIBL LIBEL

MPAY MEDICAL PAYMENTS X

MPRS MALICIOUS PROSECUTION

OTCA OTHER T

OTPI OTHER PERSONAL INJURY T

SLND SLANDER

TRSM TERRORISM

WEVC WRONGFUL EVICTION

WTRM WRONGFUL TERMINATION

163

POLICY TYPE COVERAGE TYPE LOSS TYPE CMS

CAVN COMMERCIAL LIAB LIABILITY BISF SLIP & FALL T

AVIATION BODI BODILY INJURY T

DISC DISCRIMINATION

DOGB DOG BITE T

ENVR ENVIRONMENTAL T

FALS FALSE ARREST

HARS HARASSMENT

LIAB PROPERTY DAMAGE

LIBL LIBEL

MPAY MEDICAL PAYMENTS X

MPRS MALICIOUS PROSECUTION

OTCA OTHER CASUALTY T

OTPI OTHER PERSONAL INJURY T

SLND SLANDER

TRSM TERRORISM

WEVC WRONGFUL EVICTION

WTRM WRONGFUL TERMINATION

OTLB OTHER LIABILITY BISF SLIP & FALL T

BODI BODILY INJURY T

DISC DISCRIMINATION

DOGB DOG BITE T

ENVR ENVIRONMENTAL T

FALS FALSE ARREST

HARS HARASSMENT

LIAB PROPERTY DAMAGE

LIBL LIBEL

MPAY MEDICAL PAYMENTS X

MPRS MALICIOUS PROSECUTION

OTCA OTHER T

OTPI OTHER PERSONAL INJURY T

SLND SLANDER

TRSM TERRORISM

WEVC WRONGFUL EVICTION

WTRM WRONGFUL TERMINATION

CLBO COMMERCIAL LIAB LIABILITY BISF SLIP & FALL T

BUSINESS OWNERS BODI BODILY INJURY T

DISC DISCRIMINATION

DOGB DOG BITE T

ENVR ENVIRONMENTAL T

FALS FALSE ARREST

HARS HARASSMENT

LIAB PROPERTY DAMAGE

LIBL LIBEL

MPAY MEDICAL PAYMENTS X

MPRS MALICIOUS PROSECUTION

OTCA OTHER T

OTPI OTHER PERSONAL INJURY

SLND SLANDER

TRSM TERRORISM

WEVC WRONGFUL EVICTION

WTRM WRONGFUL TERMINATION

164

POLICY TYPE COVERAGE TYPE LOSS TYPE CMS

CLBO COMMERCIAL MPAY MEDICAL BODI BODILY INJURY O

BUSINESS OWNERS PAYMENTS MPAY MEDICAL PAYMENTS O

(continued) OTLB OTHER LIABILITY BISF SLIP & FALL T

BODI BODILY INJURY T

DISC DISCRIMINATION

DOGB DOG BITE T

ENVR ENVIRONMENTAL T

HARS HARASSMENT

LIBL LIBEL

MPAY MEDICAL PAYMENTS X

MPRS MALICIOUS PROSECUTION

OTCA OTHER T

OTPI OTHER PERSONAL INJURY

TRSM TERRORISM

WEVC WRONGFUL EVICTION

WTRM WRONGFUL TERMINATION

PINJ PERSONAL INJURY BODI BODILY INJURY T

DISC DISCRIMINATION

FALS FALSE ARREST

HARS HARASSMENT

LIBL LIBEL

MPRS MALICIOUS PROSECUTION

OTCA OTHER

OTPI OTHER PERSONAL INJURY T

SLND SLANDER

WEVC WRONGFUL EVICTION

WTRM WRONGFUL TERMINATION

POLL POLLUTION BODI BODILY INJURY T

ENVR ENVIRONMENTAL T

LIAB PROPERTY DAMAGE

OTCA OTHER T

PROD PRODUCTS & BODI BODILY INJURY

COMPLETED ENVR ENVIROMENTAL

OPERATIONS LIAB LIABLITY

OTCA OTHER

165

Commercial Automobile Liability POLICY TYPE COVERAGE TYPE LOSS TYPE CMS

CAPP COMMERCIAL BODI BODILY INJURY BODI BODILY INJURY T

AUTO MPAY MEDICAL PAYMENTS X

NFLT PIP O

OTAU OTHER AUTO T

TRSM TERRORISM T

GGKP GARAGEKEEPERS BODI BODILY INJURY T

OTAU OTHER AUTO T

PRPD PROPERTY DAMAGE

MPAY MEDICAL BODI BODILY INJURY O

PAYMENTS MPAY MEDICAL PAYMENTS O

NFLT PIP O

OTAU OTHER AUTO O

TRSM TERRORISM O

NFLT PIP BODI BODILY INJURY O

NFLT PIP O

OTAU OTHER AUTO O

OTAU OTHER AUTO BODI BODILY INJURY T

MPAY MEDICAL PAYMENTS X

NFLT PIP O

OTAU OTHER AUTO T

TRSM TERRORISM T

PRPD PROPERTY OTAU OTHER AUTO

DAMAGE PRPD PROPERTY DAMAGE

TRSM TERRORISM

UNDR UNDERINSURED BODI BODILY INJURY T

MOTORIST OTAU OTHER AUTO T

PRPD PROPERTY DAMAGE

TRSM TERRORISM T

UNIN UNINSURED BODI BODILY INJURY T

MOTORIST OTAU OTHER AUTO T

PRPD PROPERTY DAMAGE

TRSM TERRORISM T

166

Personal Liability

POLICY TYPE COVERAGE TYPE LOSS TYPE CMS

PPHO HOMEOWNERS LIAB LIABILITY BISF SLIP & FALL

(includes property damage BODI BODILY INJURY T

and bodily injury) DISC DISCRIMINATION

DOGB DOG BITE T

ENVR ENVIRONMENTAL T

FALS FALSE ARREST

HARS HARASSMENT

LIAB PROPERTY DAMAGE

LIBL LIBEL

MPAY MEDICAL PAYMENTS X

MPRS MALICIOUS PROSECUTION

OTCA OTHER T

OTPI OTHER PERSONAL INJURY T

SLND SLANDER

TRSM TERRORISM T

WEVC WRONGFUL EVICTION

WTRM WRONGFUL TERMINATION

MPAY MEDICAL BODI BODILY INJURY O

PAYMENTS MPAY MEDICAL PAYMENTS O

OTLB OTHER LIABILITY BISF SLIP & FALL T

BODI BODILY INJURY T

DISC DISCRIMINATION

DOGB DOG BITE T

ENVR ENVIRONMENTAL T

FALS FALSE ARREST

LIAB PROPERTY DAMAGE

MPAY MEDICAL PAYMENTS X

OTCA OTHER T

SLND SLANDER

TRSM TERRORISM T

WEVC WRONGFUL EVICTION

PINJ PERSONAL BODI BODILY INJURY T

INJURY DISC DISCRIMINATION

FALS FALSE ARREST

HARS HARASSMENT

LIBL LIBEL

MPRS MALICIOUS PROSECUTION

OTCA OTHER T

OTPI OTHER PERSONAL INJURY T

SLND SLANDER

WEVC WRONGFUL EVICTION

WTRM WRONGFUL TERMINATION

PPFM FARMOWNERS LIAB LIABILITY BISF SLIP & FALL T

(includes property damage BODI BODILY INJURY T

and bodily injury) DISC DISCRIMINATION

DOGB DOG BITE T

ENVR ENVIRONMENTAL T

FALS FALSE ARREST

167

POLICY TYPE COVERAGE TYPE LOSS TYPE CMS

PPFM FARMOWNERS LIAB LIABILITY HARS HARASSMENT

(continued) (continued) LIAB PROPERTY DAMAGE

LIBL LIBEL

MPAY MEDICAL PAYMENTS X

MPRS MALICIOUS PROSECUTION

OTCA OTHER T

OTPI OTHER PERSONAL INJURY T

SLND SLANDER

TRSM TERRORISM T

WEVC WRONGFUL EVICTION

WTRM WRONGFUL TERMINATION

MPAY MEDICAL BODI BODILY INJURY O

PAYMENTS MPAY MEDICAL PAYMENTS O

OTLB OTHER LIABILITY BISF SLIP & FALL T

(includes property damage BODI BODILY INJURY T

and bodily injury) DISC DISCRIMINATION

DOGB DOG BITE T

ENVR ENVIRONMENTAL T

FALS FALSE ARREST

HARS HARASSMENT

LIAB PROPERTY DAMAGE

MPAY MEDICAL PAYMENTS X

MPRS MALICIOUS PROSECUTION

OTCA OTHER T

SLND SLANDER

TRSM TERRORISM T

WEVC WRONGFUL EVICTION

WTRM WRONGFUL TERMINATION

PINJ PERSONAL INJURY BODI BODILY INJURY T

DISC DISCRIMINATION

FALS FALSE ARREST

HARS HARASSMENT

LIBL LIBEL

MPRS MALICIOUS PROSECUTION

OTCA OTHER T

OTPI OTHER PERSONAL INJURY T

SLND SLANDER

TRSM TERRORISM

WEVC WRONGFUL EVICTION

WTRM WRONGFUL TERMINATION

PPMH MOBILE HOME LIAB LIABILITY BISF SLIP & FALL T

(includes property damage BODI BODILY INJURY T

and bodily injury) DISC DISCRIMINATION

DOGB DOG BITE T

ENVR ENVIRONMENTAL T

FALS FALSE ARREST

HARS HARASSMENT

LIAB PROPERTY DAMAGE

LIBL LIBEL

168

POLICY TYPE COVERAGE TYPE LOSS TYPE CMS

PPMH MOBILE HOME LIAB LIABILITY (cont) MPAY MEDICAL PAYMENTS X

(continued) MPRS MALICIOUS PROSECUTION

OTCA OTHER T

OTPI OTHER PERSONAL INJURY T

SLND SLANDER

TRSM TERRORISM T

WEVC WRONGFUL EVICTION

MPAY MEDICAL BODI BODILY INJURY O

PAYMENTS MPAY MEDICAL PAYMENTS O

OTLB OTHER LIABILITY BISF SLIP & FALL T

(includes property damage BODI BODILY INJURY T

and bodily injury) DISC DISCRIMINATION

DOGB DOG BITE T

ENVR ENVIRONMENTAL T

FALS FALSE ARREST

LIAB PROPERTY DAMAGE

MPAY MEDICAL PAYMENTS X

OTCA OTHER T

OTPI OTHER PERSONAL INJURY T

SLND SLANDER

TRSM TERRORISM T

PINJ PERSONAL INJURY BODI BODILY INJURY T

DISC DISCRIMINATION

FALS FALSE ARREST

HARS HARASSMENT

LIBL LIBEL

MPRS MALICIOUS PROSECUTION

OTCA OTHER T

OTPI OTHER PERSONAL INJURY T

SLND SLANDER

WEVC WRONGFUL EVICTION

WTRM WRONGFUL TERMINATION

PLMA PERSONAL LIAB LIABILITY BODI BODILY INJURY T

LIABILITY MARINE (including bodily injury and ENVR ENVIRONMENTAL T

property damage) LIAB PROPERTY DAMAGE

MPAY MEDICAL PAYMENTS X

OTCA OTHER CASUALTY T

TRSM TERRORISM T

OTLB OTHER LIABILITY BODI BODILY INJURY T

ENVR ENVIRONMENTAL T

LIAB PROPERTY DAMAGE

MPAY MEDICAL PAYMENTS X

TRSM TERRORISM T

PTCI PROTECTION AND BODI BODILY INJURY T

INDEMNITY LIAB PROPERTY DAMAGE

OTCA OTHER CASUALTY

BOAT BOAT LIAB LIABILITY BODI BODILY INJURY T

ENVR ENVIRONMENTAL T

LIAB PROPERTY DAMAGE

MPAY MEDICAL PAYMENTS X

OTCA OTHER CASUALTY T

169

Personal Automobile Liability

POLICY TYPE COVERAGE TYPE LOSS TYPE CMS

PAPP PERSONAL BODI BODILY INJURY BODI BODILY INJURY T

AUTO MPAY MEDICAL PAYMENTS X

NFLT PIP O

OTAU OTHER AUTO T

TRSM TERRORISM T

MPAY MEDICAL BODI BODILY INJURY O

PAYMENTS MPAY MEDICAL PAYMENTS O

NFLT NO FAULT O

OTAU OTHER AUTO O

NFLT PIP BODI BODILY INJURY O

NFLT PIP O

OTAU OTHER AUTO O

OTAU OTHER AUTO BODI BODILY INJURY T

MPAY MEDICAL PAYMENTS X

NFLT PIP O

OTAU OTHER AUTO T

TRSM TERRORISM T

PRPD PROPERTY OTAU OTHER AUTO

DAMAGE PRPD PROPERTY DAMAGE

TRSM TERRORISM

UNDR UNDERINSURED BODI BODILY INJURY T

MOTORIST OTAU OTHER AUTO T

PRPD PROPERTY DAMAGE

TRSM TERRORISM T

UNIN UNINSURED BODI BODILY INJURY T

MOTORIST OTAU OTHER AUTO T

PRPD PROPERTY DAMAGE

TRSM TERRORISM T

Workers’ Compensation

POLICY TYPE COVERAGE TYPE LOSS TYPE CMS

WCEL WORKERS COMP WCIL INDEMNITY WCIL INDEMNITY W

& EMPLOYERS WCLL LIABILITY WCLL LIABILITY W

LIABILITY WCML MEDICAL WCML MEDICAL W

WCMA WORKERS’ WCIL INDEMNITY WCIL INDEMNITY W

COMP MARINE WCLL LIABILITY WCLL LIABILITY W

WCML MEDICAL WCML MEDICAL W

PPHO PERSONAL WCIL INDEMNITY WCIL INDEMNITY W

PROP HOMEOWNERS WCLL LIABILITY WCLL LIABILITY W

WCML MEDICAL WCML MEDICAL W

170

Other

POLICY TYPE COVERAGE TYPE LOSS TYPE CMS

ACHE ACCIDENT & DISB DISABILITY DISB DISABILITY O

HEALTH HEAL HEALTH HEAL HEALTH O

LGTC LONG TERM CARE LGTC LONG TERM CARE

ACDD ACCIDENTAL DEATH AND DISMEMBERMENT

ACDD ACCIDENTAL DEATH AND DISMEMBERMENT

LIFE LIFE LIFE LIFE DEAD DEATH

171

AutoLossInfo Combinations – Please use the following policy, coverage, and loss type combinations in conjunction with the AutoLossInfo aggregate when reporting 1

st or 3

rd party auto physical damage, theft, or

salvage of a vehicle. Commercial Automobile POLICY TYPE COVERAGE TYPE LOSS TYPE

CAPP COMMERCIAL COLL COLLISION COLL COLLISION

AUTO OTAU OTHER AUTO

COMP COMPREHENSIVE ANML ANIMAL

COMP COMPREHENSIVE

FIRE FIRE

FLOD FLOOD

GLSS GLASS

HAIL HAIL

OTAU OTHER AUTO

PTFT PARTIAL THEFT

THFT THEFT

TOWL TOWING & LABOR

TRSM TERRORISM

VAMM VANDALISM & MALICIOUS MISCHIEF

GGKP GARAGEKEEPERS COLL COLLISION

OTAU OTHER AUTO

PRPD PROPERTY DAMAGE

THFT THEFT

TRSM TERRORISM

GLSS GLASS GLSS GLASS

OTAU OTHER AUTO

OTAU OTHER AUTO ANML ANIMAL

COLL COLLISION

FIRE FIRE

FLOD FLOOD

GLSS GLASS

OTAU OTHER AUTO

RENT RENTAL REIMBURSEMENT

THFT THEFT

TOWL TOWING & LABOR

TRSM TERRORISM

VAMM VANDALISM & MALICIOUS MISCHIEF

RENT RENTAL OTAU OTHER AUTO

REIMBURSEMENT RENT RENTAL REIMBURSEMENT

TOWL TOWING & OTAU OTHER AUTO

LABOR TOWL TOWING & LABOR

172

Personal Automobile

POLICY TYPE COVERAGE TYPE LOSS TYPE

PAPP PERSONAL COLL COLLISION COLL COLLISION

AUTO OTAU OTHER AUTO

COMP COMPREHENSIVE ANML ANIMAL

COMP COMPREHENSIVE

FIRE FIRE

FLOD FLOOD

GLSS GLASS

HAIL HAIL

OTAU OTHER AUTO

PTFT PARTIAL THEFT

THFT THEFT

TOWL TOWING & LABOR

TRSM TERRORISM

VAMM VANDALISM & MALICIOUS MISCHIEF

GLSS GLASS GLSS GLASS

OTAU OTHER AUTO

OTAU OTHER AUTO ANML ANIMAL

OTAU OTHER AUTO

TOWL TOWING & LABOR

TRSM TERRORISM

VAMM VANDALISM & MALICIOUS MISCHIEF

RENT RENTAL OTAU OTHER AUTO

REIMBURSEMENT RENT RENTAL REIMBURSEMENT

TOWL TOWING & OTAU OTHER AUTO

LABOR TOWL TOWING & LABOR

No Coverage/No Loss Policy Types – The following policy types will allow a liability claim to include vehicle information on an AutoLossInfo aggregate (VIN is required) without reporting coverage or loss type.

POLICY TYPE COVERAGE TYPE LOSS TYPE

CAPP COMM AUTO NCVG No Coverage NLOS No Loss

CAVN COMM AVIATION

CCGL COMM GENERAL LIABILITY

CFRM COMM FARM OWNERS

CLBO COMM BUSINESS OWNERS

COMR OCEAN MARINE

CPMP COMM MULTI PERIL

OLIB OTHER LIABILITY

PAPP PERSONAL AUTO

PLIB PERSONAL LIABILITY

PPFM PERSONAL FARM OWNERS

PPHO PERSONAL HOMEOWNERS

PPMH PERSONAL MOBILE HOME

UMBR UMBRELLA

WCEL WORK COMP & EMPLOYER LIABILITY

WCMA WORK COMP MARINE

173

Personal Property Combination Policy (Use only where Homeowner and Auto are written on the same policy.)

POLICY TYPE COVERAGE TYPE LOSS TYPE

PPHO COLL COLLISION COLL COLLISON

HOMEOWNERS OTAU OTHER AUTO

TRSM TERRORISM

COMP ANML ANIMAL

COMPREHENSIVE FIRE FIRE

FLOD FLOOD

GLSS GLASS

HAIL HAIL

OTAU OTHER AUTO

THFT THEFT

TOWL TOWING & LABOR

TRSM TERRORISM

VAMM VANDELISM & MALICIOUS MISCHIEF

GLSS GLASS GLSS GLASS

OTAU OTHER AUTO

RENT RENTAL OTAU OTHER AUTO

REIMBURSEMENT RENT RENTAL REIMBURSEMENT

TOWL TOWING & OTAU OTHER AUTO

LABOR TOWL TOWING & LABOR

174

PropertyLossInfo/ClaimsSubjectInsuranceInfo Combinations – Please use the following policy, coverage, and loss type combinations in conjunction with the PropertyLossInfo/ClaimsSubjectInsuranceInfo when reporting Fire, Theft, or Other Perils listed below. Note-Theft claims will also require the PropertyLossInfo/PropertySchedule aggregate to report the specific items stolen. Commercial Property (First Party Physical Damages)

POLICY TYPE COVERAGE TYPE LOSS TYPE

CPMP COMMERCIAL There are no coverage fields for 1

ST party property.

Coverage will be determined based on the a dollar amount provided in the following fields of the PropertyLossInfo: Building, Contents, Loss of Use, Stock, and Other Property

ACFT AIRCRAFT

PROPERTY BURG BURGLARY

CFRM FARMOWNERS CLPS COLLAPSE

CPFR FIRE CNTP CONTAMINATION/ CPAO ALLIED/OTHER POLLUTION

CPBO BUSINESS COLL COLLISION

OWNERS CRCK CRACKING/RUPTURE

CCRM CRIME/ BURGLARY

ELEC ELECTRIC CURRENT

CIMR INLAND MARINE ERTH EARTHQUAKE/MOVEMENT

COMR OCEAN MARINE EXPL EXPLOSION

CAVN AVIATION FDTY FIDELITY

FSUR FIDELITY & FIRE FIRE

SURETY FLOD FLOOD

CPOP OTHER FOBJ FALLING OBJECTS

BMCH BOILER & FREZ FREEZING

MACHINERY GLSS GLASS

CRGO CARGO HAIL HAIL

LSTK LIVESTOCK LGHT LIGHTNING

LOBG LOST BAGGAGE

LVMT LIVESTOCK MORTALITY

MOLD MOLD

MYSD MYSTERIOUS DISAPPEARANCE

OTPR OTHER PERILS

RIOT RIOT/CIVIL COMMOTION

ROBB ROBBERY

SINK SINKING

SMOK SMOKE

SNKL SINKHOLE

SRTY SURETY

THFT THEFT

TRSM TERRORISM

UPST UPSET, OVER TURN

VAMM VANDALISM & MALICIOUS MISCHIEF

VHCL VEHICLES

VOLC VOLCANIC ERUPTION

WATR WATER

WIND WIND

WISS WEIGHT ICE/SNOW/SLEET

175

Personal Property (First Party Physical Damages)

POLICY TYPE COVERAGE TYPE LOSS TYPE

PPHO HOMEOWNERS There are no coverage fields for 1

st party property.

Coverage will be determined based on the a dollar amount provided in the following fields of the PropertyLossInfo: Building, Contents, Loss of Use, Stock, and Other Property

ACFT AIRCRAFT

PPFM FARMOWNERS BURG BURGLARY

PPFR FIRE CLPS COLLAPSE

PPAO ALLIED/OTHER CNTP CONTAMINATION/ POLLUTION

PPMH MOBILE HOME CRCK CRACKING/RUPTURE

PPIM INLAND ELEC ELECTRIC CURRENT

MARINE ERTH EARTHQUAKE/MOVEMENT

PPMA MARINE EXPL EXPLOSION

PPOP OTHER FDTY FIDELITY

WCFT UNSCHEDULED FIRE FIRE

WATERCRAFT FLOD FLOOD

FOBJ FALLING OBJECTS

FREZ FREEZING

GLSS GLASS

HAIL HAIL

LGHT LIGHTNING

LOBG LOST BAGGAGE

LVMT LIVESTOCK/MORTALITY

MOLD MOLD

MYSD MYSTERIOUS DISAPPEARANCE

OTPR OTHER PERILS

RIOT RIOT/CIVIL COMMOTION

ROBB ROBBERY

SMOK SMOKE

SNKL SINKHOLE

THFT THEFT

TRSM TERRORISM

VAMM VANDALISM & MALICIOUS MISCHIEF

VHCL VEHICLES

VOLC VOLCANIC ERUPTION

WATR WATER

WIND WIND

WISS WEIGHT ICE/ SNOW/ SLEET

176

Personal Automobile Combination Policy – Use only where Homeowner and Auto are written on the same policy. For non-combination policies, the combinations found in the previous tables should be used.

POLICY TYPE COVERAGE TYPE LOSS TYPE

PAPP PERSONAL PROP GENERAL ACFT AIRCRAFT

AUTO PROPERTY (if reported on BURG BURGLARY

AutoLossInfo) CLPS COLLAPSE

CNTP CONTAMINATION/ POLLUTION

There are no coverage fields for 1

st party property.

Coverage will be determined based on the a dollar amount provided in the following fields: Building, Contents, Loss of Use, Stock, and Other Property (if reported on PropertyLossInfo)

CRCK CRACKING/RUPTURE

ELEC ELECTRIC CURRENT

ERTH EARTHQUAKE/MOVEMENT

EXPL EXPLOSION

FDTY FIDELITY

FIRE FIRE

FLOD FLOOD

FOBJ FALLING OBJECTS

FREZ FREEZING

GLSS GLASS

HAIL HAIL

LGHT LIGHTNING

LOBG LOST BAGGAGE

LVMT LIVESTOCK/MORTALITY

MOLD MOLD

MYSD MYSTERIOUS DISAPPEARANCE

OTPR OTHER PERILS

RIOT RIOT/CIVIL COMMOTION

ROBB ROBBERY

SMOK SMOKE

SNKL SINKHOLE

THFT THEFT

TRSM TERRORISM

VAMM VANDALISM & MALICIOUS MISCHIEF

VHCL VEHICLES

VOLC VOLCANIC ERUPTION

WATR WATER

WIND WIND

WISS WEIGHT ICE/ SNOW/ SLEET

177

PropertyLossInfo/Watercraft Combinations – Please use the following policy, coverage, and loss types in conjunction with the PropertyLossInfo/Watercraft when reporting claims for scheduled boats listed under separate policy, or for off-road or mobile equipment. Note – Where multiple Policy Types are listed next to a single Coverage Type, all coverage/loss type combinations may be used with any of the listed policy types.

Personal Property – Boat

POLICY TYPE COVERAGE TYPE LOSS TYPE

BOAT BOAT POLICIES HULL HULL ACFT AIRCRAFT

PPHO HOMEOWNERS (use for all general boat BURG BURGLARY

PPFM FARMOWNERS losses) CLPS COLLAPSE

PPMH MOBILEHOME CNTP CONTAMINATION/ POLLUTION

PPIM PERSONAL COLL COLLISION

INLAND MARINE CRCK CRACKING/RUPTURE

PPMA PERSONAL ELEC ELECTRIC CURRENT

PROP MARINE ERTH EARTHQUAKE/MOVEMENT

PPOP OTHER PERS. EXPL EXPLOSION

PROP. FIRE FIRE

FLOD FLOOD

FOBJ FALLING OBJECTS

FREZ FREEZING

GLSS GLASS

HAIL HAIL

LGHT LIGHTNING

OTPR OTHER

RIOT RIOT

SINK SINKING

SMOK SMOKE

SNKL SINKHOLE

THFT THEFT

TRSM TERRORISM

UPST UPSET, OVER TURN

VAMM VANDALISM & MALICIOUS MISCHIEF

VHCL VEHICLES

VOLC VOLCANIC ERUPTION

WIND WIND

WATR WATER

WISS WEIGHT ICE/SNOW/SLEET

BOAT BOAT POLICIES MOTR MOTOR ACFT AIRCRAFT

PPHO HOMEOWNERS (use when loss involves boat CLPS COLLAPSE

PPFM FARMOWNERS engine & equipment) CNTP CONTAMINATION/ POLLUTION

PPMH MOBILEHOME COLL COLLISION

PPIM PERSONAL CRCK CRACKING/RUPTURE

INLAND MARINE ELEC ELECTRIC CURRENT

PPMA PERSONAL ERTH EARTHQUAKE/MOVEMENT

PROP MARINE EXPL EXPLOSION

PPOP OTHER PERS. FIRE FIRE

PROP. FLOD FLOOD

FOBJ FALLING OBJECTS

FREZ FREEZING

HAIL HAIL

178

POLICY TYPE COVERAGE TYPE LOSS TYPE

ALL POLICIES MOTR MOTOR LGHT LIGHTNING

ABOVE(continued) (continued) OTPR OTHER

RIOT RIOT

SINK SINKING

SMOK SMOKE

SNKL SINKHOLE

THFT THEFT

TRSM TERRORISM

UPST UPSET, OVER TURN

VAMM VANDALISM & MALICIOUS MISCHIEF

VHCL VEHICLES

VOLC VOLCANIC ERUPTION

WIND WIND

WATR WATER

WISS WEIGHT ICE/SNOW/SLEET

BOAT BOAT POLICIES OTPR OTHER PROP ACFT AIRCRAFT

PPHO HOMEOWNERS BURG BURGLARY

PPFM FARMOWNERS CLPS COLLAPSE

PPMH MOBILEHOME CNTP CONTAMINATION/ POLLUTION

PPIM PERSONAL COLL COLLISION

INLAND MARINE CRCK CRACKING

PPMA PERSONAL ELEC ELECTRIC CURRENT

PROP MARINE ERTH EARTHQUAKE/MOVEMENT

PPOP OTHER PERS. EXPL EXPLOSION

PROP. FDTY FIDELITY

FIRE FIRE

FLOD FLOOD

FOBJ FALLING OBJECTS

FREZ FREEZING

GLSS GLASS

HAIL HAIL

LGHT LIGHTNING

OTPR OTHER

RIOT RIOT

ROBB ROBBERY

SINK SINKING

SMOK SMOKE

SNKL SINKHOLE

THFT THEFT

TRSM TERRORISM

UPST UPSET, OVER TURN

VAMM VANDALISM & MALICIOUS MISCHIEF

VHCL VEHICLES

VOLC VOLCANIC ERUPTION

WATR WATER

WIND WIND

WISS WEIGHT ICE/SNOW/SLEET

179

Commercial Property – Boat

POLICY TYPE COVERAGE TYPE LOSS TYPE

CPMP COMM. PROP HULL HULL ACFT AIRCRAFT

MULTI PERIL (use for all general boat BURG BURGLARY

CFRM COMMERCIAL losses) CLPS COLLAPSE

FARM POLICY CNTP CONTAMINATION/ POLLUTION

CPBO BUSINESS COLL COLLISION

OWNERS CRCK CRACKING/RUPTURE

CIMR COMMERCIAL ELEC ELECTRIC CURRENT

INLAND MARINE ERTH EARTHQUAKE/MOVEMENT

COMR COMM. MARINE EXPL EXPLOSION

CAVN COMMERCIAL FIRE FIRE

AVIATION FLOD FLOOD

CPOP COMM. PROP. FOBJ FALLING OBJECTS

OTHER FREZ FREEZING

CRGO CARGO GLSS GLASS

HAIL HAIL

LGHT LIGHTNING

OTPR OTHER

RIOT RIOT

SINK SINKING

SMOK SMOKE

SNKL SINKHOLE

THFT THEFT

TRSM TERRORISM

UPST UPSET, OVER TURN

VAMM VANDALISM & MALICIOUS MISCHIEF

VHCL VEHICLES

VOLC VOLCANIC ERUPTION

WIND WIND

WATR WATER

WISS WEIGHT ICE/SNOW/SLEET

CPMP COMM. PROP MOTR MOTOR ACFT AIRCRAFT

MULTI PERIL (use when loss involves boat CLPS COLLAPSE

CFRM COMMERCIAL engine & equipment) CNTP CONTAMINATION/ POLLUTION

FARM POLICY COLL COLLISION

CPBO BUSINESS CRCK CRACKING/RUPTURE

OWNERS ELEC ELECTRIC CURRENT

CIMR COMMERCIAL ERTH EARTHQUAKE/MOVEMENT

INLAND MARINE EXPL EXPLOSION

COMR COMM. MARINE FIRE FIRE

CAVN COMMERCIAL FLOD FLOOD

AVIATION FOBJ FALLING OBJECTS

FREZ FREEZING

HAIL HAIL

LGHT LIGHTNING

OTPR OTHER

RIOT RIOT

SINK SINKING

180

POLICY TYPE COVERAGE TYPE LOSS TYPE

ALL POLICIES MOTR MOTOR SMOK SMOKE

ABOVE (continued) (continued) SNKL SINKHOLE

THFT THEFT

TRSM TERRORISM

UPST UPSET, OVER TURN

VAMM VANDALISM & MALICIOUS MISCHIEF

VHCL VEHICLES

VOLC VOLCANIC ERUPTION

WIND WIND

WATR WATER

WISS WEIGHT ICE/SNOW/SLEET

CPMP COMM. PROP OTPR OTHER ACFT AIRCRAFT

MULTI PERIL PROPERTY BURG BURGLARY

CFRM COMMERCIAL CLPS COLLAPSE

FARM POLICY CNTP CONTAMINATION/ POLLUTION

CPBO BUSINESS COLL COLLISION

OWNERS CRCK CRACKING

CIMR COMMERCIAL ELEC ELECTRIC CURRENT

INLAND MARINE ERTH EARTHQUAKE/MOVEMENT

COMR COMM. MARINE EXPL EXPLOSION

CAVN COMMERCIAL FDTY FIDELITY

AVIATION FIRE FIRE

FLOD FLOOD

FOBJ FALLING OBJECTS

FREZ FREEZING

GLSS GLASS

HAIL HAIL

LGHT LIGHTNING

OTPR OTHER

RIOT RIOT

ROBB ROBBERY

SINK SINKING

SMOK SMOKE

SNKL SINKHOLE

THFT THEFT

TRSM TERRORISM

UPST UPSET, OVER TURN

VAMM VANDALISM & MALICIOUS MISCHIEF

VHCL VEHICLES

VOLC VOLCANIC ERUPTION

WATR WATER

WIND WIND

WISS WEIGHT ICE/SNOW/SLEET

181

Personal Automobile Combination Policy – The following policy/coverage/loss type combinations below should ONLY be used if the policy is a Personal Combination Policy. For non-Combination Policies, the combinations found in the previous tables should be used.

POLICY TYPE COVERAGE TYPE LOSS TYPE

PAPP PERSONAL HULL HULL ACFT AIRCRAFT

AUTO (use for all general boat BURG BURGLARY

losses) CLPS COLLAPSE

CNTP CONTAMINATION/ POLLUTION

COLL COLLISION

CRCK CRACKING/RUPTURE

ELEC ELECTRIC CURRENT

ERTH EARTHQUAKE/MOVEMENT

EXPL EXPLOSION

FIRE FIRE

FLOD FLOOD

FOBJ FALLING OBJECTS

FREZ FREEZING

HAIL HAIL

LGHT LIGHTNING

OTPR OTHER

RIOT RIOT

SINK SINKING

SMOK SMOKE

SNKL SINKHOLE

THFT THEFT

TRSM TERRORISM

UPST UPSET, OVER TURN

VAMM VANDALISM & MALICIOUS MISCHIEF

VHCL VEHICLES

VOLC VOLCANIC ERUPTION

WIND WIND

WATR WATER

WISS WEIGHT ICE/SNOW/SLEET

MOTR MOTOR ACFT AIRCRAFT

(use when loss involves boat CLPS COLLAPSE

engine & equipment) CNTP CONTAMINATION/ POLLUTION

COLL COLLISION

CRCK CRACKING/RUPTURE

ELEC ELECTRIC CURRENT

ERTH EARTHQUAKE/MOVEMENT

EXPL EXPLOSION

FIRE FIRE

FLOD FLOOD

FOBJ FALLING OBJECTS

FREZ FREEZING

HAIL HAIL

LGHT LIGHTNING

182

POLICY TYPE COVERAGE TYPE LOSS TYPE

PAPP PERSONAL MOTR MOTOR OTPR OTHER

AUTO (continued) (continued) RIOT RIOT

SINK SINKING

SMOK SMOKE

SNKL SINKHOLE

THFT THEFT

TRSM TERRORISM

UPST UPSET, OVER TURN

VAMM VANDALISM & MALICIOUS MISCHIEF

VHCL VEHICLES

VOLC VOLCANIC ERUPTION

WIND WIND

WATR WATER

WISS WEIGHT ICE/SNOW/SLEET

OTPR OTHER ACFT AIRCRAFT

PROPERTY CLPS COLLAPSE

CNTP CONTAMINATION/ POLLUTION

COLL COLLISION

CRCK CRACKING/RUPTURE

ELEC ELECTRIC CURRENT

ERTH EARTHQUAKE/MOVEMENT

EXPL EXPLOSION

FIRE FIRE

FLOD FLOOD

FOBJ FALLING OBJECTS

FREZ FREEZING

HAIL HAIL

LGHT LIGHTNING

OTPR OTHER

183

PropertyLossInfo/ItemInfo Combinations – Please use the following policy, coverage, and loss types in conjunction with the PropertyLossInfo/ItemInfo when reporting claims for off-road or mobile equipment. Note – Where multiple Policy Types are listed next to a single Coverage Type, all coverage/loss type combinations may be used with any of the listed policy types. Personal Property – Mobile Equipment

POLICY TYPE COVERAGE TYPE LOSS TYPE

MOBL MOBILE OTPR OTHER ACFT AIRCRAFT

EQUIPMENT PROPERTY BURG BURGLARY

PPHO HOMEOWNERS CLPS COLLAPSE

PPFM FARMOWNERS CNTP CONTAMINATION/ POLLUTION

PPMH MOBILEHOME COLL COLLISION

PPIM PERSONAL CRCK CRACKING

INLAND MARINE ELEC ELECTRIC CURRENT

PPMA PERSONAL ERTH EARTHQUAKE

PROP MARINE EXPL EXPLOSION

PPOP PERSONAL FDTY FIDELITY

PROP OTHER FIRE FIRE

FLOD FLOOD

FOBJ FALLING OBJECTS

FREZ FREEZING

HAIL HAIL

LGHT LIGHTNING

OTPR OTHER

RIOT RIOT

ROBB ROBBERY

SINK SINKING

SMOK SMOKE

SNKL SINKHOLE

THFT THEFT

TRSM TERRORISM

UPST UPSET, OVER TURN

VAMM

VANDALISM & MALICIOUS MISCHIEF

VOLC VOLCANIC ERUPTION

WIND WIND

WISS WEIGHT ICE/SNOW/SLEET

184

Commercial Property – Mobile Equipment

POLICY TYPE COVERAGE TYPE LOSS TYPE

CPMP COMM. PROP OTPR OTHER ACFT AIRCRAFT

MULTI PERIL PROPERTY BURG BURGLARY

CFRM COMM. FARM CLPS COLLAPSE

CPBO BUSINESS CNTP CONTAMINATION/ POLLUTION

OWNERS COLL COLLISION

CIMR COMM INLAND CRCK CRACKING

MARINE ELEC ELECTRIC CURRENT

COMR COMM. MARINE ERTH EARTHQUAKE

CAVN COMMERCIAL EXPL EXPLOSION

AVIATION FDTY FIDELITY

CPOP COMM. PROP FIRE FIRE

OTHER FLOD FLOOD

CRGO CARGO PROP FOBJ FALLING OBJECTS

MARINE FREZ FREEZING

HAIL HAIL

LGHT LIGHTNING

OTPR OTHER

RIOT RIOT

ROBB ROBBERY

SINK SINKING

SMOK SMOKE

SNKL SINKHOLE

THFT THEFT

TRSM TERRORISM

UPST UPSET, OVER TURN

VAMM VANDALISM & MALICIOUS MISCHIEF

VOLC VOLCANIC ERUPTION

WIND WIND

WISS WEIGHT ICE/SNOW/SLEET

Personal Automobile Combination Policy – The following policy/coverage/loss type combinations below should ONLY be used if the policy is a Personal Combination Policy. For non-Combination Policies, the combinations found in the previous tables should be used.

POLICY TYPE COVERAGE TYPE LOSS TYPE

PAPP PERSONAL AUTO MOTR MOTOR ACFT AIRCRAFT

(use when loss involves boat CLPS COLLAPSE

engine & equipment) CNTP CONTAMINATION/ POLLUTION

COLL COLLISION

CRCK CRACKING/RUPTURE

ELEC ELECTRIC CURRENT

ERTH EARTHQUAKE/MOVEMENT

EXPL EXPLOSION

FIRE FIRE

FLOD FLOOD

FOBJ FALLING OBJECTS

FREZ FREEZING

HAIL HAIL

LGHT LIGHTNING

185

POLICY TYPE COVERAGE TYPE LOSS TYPE

PAPP PERSONAL MOTR MOTOR OTPR OTHER

AUTO (continued) (continued) RIOT RIOT

SINK SINKING

SMOK SMOKE

SNKL SINKHOLE

THFT THEFT

TRSM TERRORISM

UPST UPSET, OVER TURN

VAMM VANDALISM & MALICIOUS MISCHIEF

VHCL VEHICLES

VOLC VOLCANIC ERUPTION

WIND WIND

WATR WATER

WISS WEIGHT ICE/SNOW/SLEET

186

APPENDIX C – FIELD AND RELATIONSHIP EDITS

The following lists types of invalid information for each field. This is not a complete list. Please contact ISO ClaimSearch for a complete list of edits. If ISO ClaimSearch receives a large number of cases involving a specific invalid word or variation of those listed below, it may be added to the editing rules. NOTE – This appendix does not provide information on XML transmission errors including hierarchy failures, only the edits on individual fields. Do not submit claims when a required field is not known. The Insuring Company ID <AgencyId> is required and must be reported with all claims. Fields containing words such as n/a, na, none, not known, not knwn, not-known, same (for a name field),

uk, ukn, unk, unk., unkn, unknown or variations of these words should be screened and removed. If the field is required, and removing the invalid data would cause the entire field to be blank, do not submit the claim, as it will reject.

Claim Number and Policy Number are required. Claim and Policy Numbers containing only dashes, only

question marks, and variations of n/a, na, none, not known, not knwn, not-known, same, uk, ukn, unk, unk., unkn, unknown are not allowed. All special characters will be removed and the claim or policy number will be compressed. Self-insureds that do not use policy numbers can populate the policy number field with any unique alpha numeric entry.

The following are general editing rules for the name fields (Claimant Name, Insured Name, Previous Name,

etc.). Please contact ISO ClaimSearch for a list of all entries considered to be invalid for the name, address and required numeric fields.

Name fields should contain names, not other information.

The Claimant's Last Name field must contain at least two letters.

The Claimant's First Name field must contain at least one letter.

Abbreviations or substitutions such as: UNKNOWN, UNK, N/A, etc. will not be accepted by the system

"Informational" entries such as: SPOUSE, DAUGHTER, SAME, NONE, etc. will not be accepted by the system.

XML has a special set of characters that cannot be used in normal XML strings. These characters

are: 1. & - &amp; 2. < - &lt; 3. > - &gt; 4. " - &quot; 5. ' - &#39;

(For example, the following XML string is invalid: <Organization>IBM & Microsoft</Organization> Whereas the following is valid XML: <Organization>IBM &amp; Microsoft</Organization> Note: We have replaced '&' with '&amp;' in the second XML string which makes it valid.)

Claimant Street and Claimant City are required. The following values are invalid: only dashes, only x's, question marks, n/a, na, none, not known, not knwn, not-known, periods, same, uk, ukn, unk, unk., unkn, unknown.

Claimant State must be present and valid. Any state code you provide must be a valid US or Canadian

postal service abbreviation. If the Country field is blank, US or Canada (CA), State will be edited, if other than blank, US or CA, no edit will be made on the State field. See Appendix A for valid State and Province codes.

Dates should always be sent in the format YYYY-MM-DD.

187

Numeric fields on input records containing no data may be reported as blanks or zero filled. Numeric fields on input records containing data should be right justified and zero filled. A zero in a Dollar Amount field may represent either zero payment, or may reflect that field was not reported to the database. All dollar amounts must be reported in whole dollars, EXCEPT on the <com.iso_CovInfo1> aggregate

All lower case letters in data fields are converted by the ISO ClaimSearch system to upper case. Dashes and apostrophes are not removed from individual last names reported in a Claims Party. Entering “Invalid” Names

ISO ClaimSearch maintains a list of entries that are considered to be invalid names, such as NA, UNKNOWN, UNK, NO, etc., because they are usually entered when complete information is not available. We believe the edits are necessary to prevent incorrect data from being added to the database. However, we do realize that there are occasions when one of these entries is the individual’s real name. If your claim rejects for an invalid name and you have verified that it is correct, you may enter parentheses around the name, for example (NA), in order to get the name into the database. Any claimant name, insured name, AKA name or additional claimant name entered with parentheses around the name will now be accepted into the system. The parentheses will be dropped when the clam is added to the database and will not be displayed on ISO formatted reports. Any future replacements or updates of this name must also contain the parentheses around the name. These names may be entered through your automated system, if you have the capability of doing so, or may be entered through the ISO ClaimSearch website. NOTE: This process should be used only when you have verified the name. ISO randomly performs audits to check for data quality issues. If we suspect that this process is being used just to bypass edits, you will be contacted. Increased Record Limit

Universal Format previously had a 150-record limit. If you submitted a claim that exceeded this limit, the entire file would reject. We realize that there is an increasing need to enter larger claims into the system, specifically with the Medicare Section 111 reporting in which new required records were added, and service providers and additional claimants must be reported. Whereas the 150-record limit was usually sufficient in the past, lately there are more claims exceeding the limit. ISO ClaimSearch has now increased the limit to 600. You can now report up to 600 records on an individual claim. If the new record limit is exceeded, the Hierarchy Error Message will read ‘The Quantity of records following the last Group-Header Record exceeds 600.” XML Note – The limits above reference Universal Format record counts. The XML equivalent is more difficult to calculate. Some guidelines to assist in judging the size of an XML claim:

A claims party with coverage will count as at least two records

Each alias or service provider for a claims party will count as one record

Our system is limited to only searching the first 99 claims parties on a claim. (Any claims parties submitted beyond 99 will be accepted into the system, but will not generate search results.)

The change to increase the record limit is intended to provide you with the ability to report more involved parties and other required records, as well as to report service providers that are directly related to the claim. In some instances, we have seen excessive duplicate reporting of service providers due to slight differences in spelling of the provider name. Please use this enhancement to report pertinent information on a claim. ISO performs random audits to check for data quality issues. You will be contacted if we feel that you are sending large claims with unnecessary information.

188

Please keep in mind that the ISO ClaimSearch website does have limitations for handling large claims. Although system-to-system companies will be able to send these large claims, you will not be able to update those claims via the ISO ClaimSearch website. Future updates to those claims must be made through your system. In addition, when there are matches on the large claims via the web, Claims Reporting users will not be able to see all of the details on these large claims; you must retrieve the details through Claims Inquiry or via ISO ClaimSearch Customer Service. Error Code Definitions

The format for error codes will be MMMMFFX, where MMMM is the record type failing the edit, FF is the field number where the error occurred, and X is a “B” for blank or missing, or “I” for invalid. The information in parentheses is adding the XML tag names or aggregates to the Universal Format error codes for the purpose of debugging the XML error. The information in parenthesis is not actually returned in the error code. ERROR CODE DESCRIPTION

UA0101 (ClaimInvestigationAddRq) Report Type (ReplacementInd) Missing or Invalid

UA0102 (Policy) Insurance Company Code (AgencyId) Missing or Invalid

UA0103 (Policy) Policy Number (PolicyNumber) Missing or Invalid

UA0104 (ClaimsOccurrence) Policy Type (LOBCd) Missing or Invalid

UA0109 (ClaimsOccurrence) Claim Number (ItemIdInfo/InsurerId) Missing or Invalid

UA0110 (ClaimsOccurrence) Date of Loss (LossDt) Missing or Invalid

UA0119 (ClaimsOccurrence) Location of Loss State (Addr/State) Missing or Invalid

UO0101 (ClaimsParty) Role Code (ClaimsPartyInfo/ClaimsPartyRoleCd) Missing or Invalid (where role code is from Involved Party list on Appendix D)

UO0102 (ClaimsParty) Individual or Business Indicator Missing or Invalid In XML, this indicator is derived from the correct use of the <CommlName> vs. <PersonName> aggregates. If this error is received, then a ClaimsParty name has been coded incorrectly.

UO0103 (ClaimsParty) Business Name (CommlName) Missing or Invalid

UO0104 (ClaimsParty) Last Name (PersonName/Surname)Missing or Invalid

UO0105 (ClaimsParty) First Name (PersonName/Surname) Missing or Invalid

UO0115 (ClaimsParty) Address Line 1 (Addr/Addr1) Missing or Invalid

UO0117 (ClaimsParty) Address City (Addr/City) Missing or Invalid

UO0118 (ClaimsParty) Address State (Addr/StateProvCd) Missing or Invalid

UC0106 (AdjusterPartyInfo) Loss Type (LossCauseCd for Casualty Claim) Missing or Invalid

UC0107 (AdjusterPartyInfo) Coverage Type (CoverageCd for Casualty Claim) Missing or Invalid

UC0108 (ClaimsInjuredInfo) Alleged Injuries/Property Damage (ClaimsInjury/InjuryNatureDesc) Missing or Invalid

UP0106 (AdjusterPartyInfo) Loss Type (LossCauseCd for Property Claim) Missing or Invalid

UP0135 (PropertyLossInfo) Audio/Visual Information (SubjectInsuranceCd) Missing or Invalid

UP0136 (PropertyLossInfo) Art/Antique (SubjectInsuranceCd) Missing or Invalid

UP0137 (PropertyLossInfo) Cash (SubjectInsuranceCd) Missing or Invalid

UP0138 (PropertyLossInfo) Clothing (SubjectInsuranceCd) Missing or Invalid

UP0139 (PropertyLossInfo) Computer Equipment (SubjectInsuranceCd) Missing or Invalid

UP0140 (PropertyLossInfo) Furs (SubjectInsuranceCd) Missing or Invalid

UP0141 (PropertyLossInfo) Guns (SubjectInsuranceCd) Missing or Invalid

UP0142 (PropertyLossInfo) Jewelry (SubjectInsuranceCd) Missing or Invalid

UP0143 (PropertyLossInfo) Silverware (SubjectInsuranceCd) Missing or Invalid

UP0144 (PropertyLossInfo) Sports Equipment (SubjectInsuranceCd) Missing or Invalid

UP0145 (PropertyLossInfo) Tools (SubjectInsuranceCd) Missing or Invalid

UP0146 (PropertyLossInfo) Office Equipment (SubjectInsuranceCd) Missing or Invalid

189

UP0147 (PropertyLossInfo) Other (SubjectInsuranceCd) Missing or Invalid

UP0206 (AdjusterPartyInfo) Loss Type (LossCauseCd for Boat or Mobile Equipment) Missing or Invalid

UP0207 (AdjusterPartyInfo) Coverage Type (CoverageCd for Boat or Mobile Equipment) Missing or Invalid

UP0210 (Watercraft) Boat Year (ItemDefinition/ModelYear) Missing or Invalid

UP0211 (Watercraft) Boat Make (ItemDefinition/Manufacturer) Missing or Invalid

UP0217 (Watercraft) Boat HIN (ItemDefinition/SerialIdNumber) Missing or Invalid

UP0226 (ItemInfo) Mobile Equipment Year (ItemDefinition/ModelYear) Missing or Invalid

UP0227 (ItemInfo) Mobile Equipment Make (ItemDefinition/ManufacturerCd) Missing or Invalid

UP0228 (ItemInfo) Mobile Equipment Model (ItemDefinition/ModelCd) Missing or Invalid

UP0230 (ItemInfo) Mobile Equipment VIN (SerialIdNumber) Missing or Invalid

UP0236 (RecoveryInfo) Date of Recovery (RecoveryDt) Missing or Invalid

UP0237 (RecoveryInfo) Recovery Agency (RecoveryAgencyRef – requires ClaimsParty for Recovery Agency as well) Missing or Invalid

UP0242 (RecoveryInfo) Condition of Recovered Vehicle (RecoveryStatusCd) Missing or Invalid

UP0901 (AutoLossInfo) VIN (VehInfo/VehIdentificationNumber) Missing or Invalid

UP0905 (SalvageInfo) Date of Salvage (SalvageDt) Missing or Invalid

UP0909 (SalvageInfo) Owner Retaining Salvage Indicator (OwnerRetainingSalvageInd) Missing or Invalid

UP0910 (ClaimsParty – Salvage Buyer)

Individual or Business Indicator Missing or Invalid In XML, this indicator is derived from the correct use of the <CommlName> vs. <PersonName> aggregates. If this error is received, then a ClaimsParty name has been coded incorrectly.

UP0911 (ClaimsParty – Salvage Buyer)

Buyers Business Name Missing or Invalid. The Buyer is reported in its own ClaimsParty aggregate with a BuyerRef in the SalvageInfo (CommlName is missing or invalid)

UP0912 (ClaimsParty – Salvage Buyer)

Buyers Last Name Missing or Invalid. The Buyer is reported in its own ClaimsParty aggregate with a BuyerRef in the SalvageInfo (PersonName/Surname is missing or invalid)

UP0913 (ClaimsParty – Salvage Buyer)

Buyers First Name Missing or Invalid. The Buyer is reported in its own ClaimsParty aggregate with a BuyerRef in the SalvageInfo (PersonName/GivenName is missing or invalid)

USP101 (ClaimsParty – Service Provider)

Role Code (ClaimsPartyInfo/ClaimsPartyRoleCd) Missing or Invalid (where role code is from Service Provider list on Appendix D)

USP102 (ClaimsParty – Service Provider)

Individual or Business Indicator Missing or Invalid In XML, this indicator is derived from the correct use of the <CommlName> vs. <PersonName> aggregates. If this error is received, then a ClaimsParty name for a Service Provider is missing or has been coded incorrectly.

USP103 (ClaimsParty – Service Provider)

Business Name (CommlName) Missing or Invalid

USP104 (ClaimsParty – Service Provider)

Last Name (PersonName/Surname)Missing or Invalid

USP105 (ClaimsParty – Service Provider)

First Name (PersonName/Surname) Missing or Invalid

USP114 (ClaimsParty – Service Provider)

Address Line 1 (Addr/Addr1) Missing or Invalid (only for searchable service provider role codes)

USP116 (ClaimsParty – Service Provider)

Address City (Addr/City) Missing or Invalid

USP117 (ClaimsParty – Service Provider)

Address State (Addr/StateProvCd) Missing or Invalid

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UV0106 (AdjusterParty Info)

Loss Type (LossCauseCd for Vehicle Claim) Missing or Invalid

UV0107 (AdjusterPartyInfo) Coverage Type (CoverageCd for Vehicle Claim) Missing or Invalid

UV0108 (AutoLossInfo) Vehicle Year (VehInfo/ModelYear) Missing or Invalid

UV0109 (AutoLossInfo) Vehicle Make (ManufacturerCd) Missing or Invalid

UV0116 (AutoLossInfo) VIN (VehInfo/VehIdentificationNumber) Missing or Invalid

UV0117 (AutoLossInfo) Coverage/loss types NCVG/NLOS must have an associated UC01 record (ClaimsInjuredInfo).

UV0142 (RecoveryInfo) Date of Recovery (RecoveryDt) Missing or Invalid

UV0143 (RecoveryInfo) Recovery Agency (RecoveryAgencyRef – requires ClaimsParty for Recovery Agency as well) Missing or Invalid

UV0148 (RecoveryInfo) Vehicle Recovery Condition (RecoveryStatusCd) Missing or Invalid

UV0901 (AutoLossInfo) VIN (VehInfo/VehIdentificationNumber) Missing or Invalid

UV0905 (SalvageInfo) Date of Salvage (SalvageDt) Missing or Invalid

UV0909 (SalvageInfo) Owner Retaining Salvage Indicator (OwnerRetainingSalvageInd) Missing or Invalid

UV0910 (ClaimsParty – Salvage Buyer)

Individual or Business Indicator Missing or Invalid In XML, this indicator is derived from the correct use of the <CommlName> vs. <PersonName> aggregates. If this error is received, then a ClaimsParty name has been coded incorrectly.

UV0911 (ClaimsParty – Salvage Buyer)

Buyers Business Name Missing or Invalid. The Buyer is reported in its own ClaimsParty aggregate with a BuyerRef in the SalvageInfo (CommlName is missing or invalid)

UV0912 (ClaimsParty – Salvage Buyer)

Buyers Last Name Missing or Invalid. The Buyer is reported in its own ClaimsParty aggregate with a BuyerRef in the SalvageInfo (PersonName/Surname is missing or invalid)

UV0913 (ClaimsParty – Salvage Buyer)

Buyers First Name Missing or Invalid. The Buyer is reported in its own ClaimsParty aggregate with a BuyerRef in the SalvageInfo (PersonName/GivenName is missing or invalid)

UV0914 (SalvageInfo) UV01 (AutoLossInfo) Must Proceed the UV09 (SalvageInfo)

US0101 (Policy) Insurance Company (AgencyId) Missing or Invalid

US0102 (Policy) Policy Number (PolicyNumber) Missing or Invalid

US0103 (ClaimsOccurrence) Claim Number (ItemIdInfo/InsurerId) Missing or Invalid

US0104 (ClaimsOccurrence) Date of Loss (LossDt) Missing or Invalid

US0201 (Policy) Insurance Company (AgencyId) Missing or Invalid

US0202 (Policy) Policy Number (PolicyNumber) Missing or Invalid

US0203 (ClaimsOccurrence) Claim Number (ItemIdInfo/InsurerId) Missing or Invalid

US0204 (ClaimsOccurrence) Date of Loss (LossDt) Missing or Invalid

US0205 (com.iso_Update) Individual or Business Indicator Missing or Invalid In XML, this indicator is derived from the correct use of the <CommlName> vs. <PersonName> aggregates. If this error is received, then a ClaimsParty name has been coded incorrectly.

US0206 (com.iso_Update) Business Name (com.iso_OriginalFields/CommercialName) Missing or Invalid

US0207 (com.iso_Update) Last Name (com.iso_OriginalFields/PersonName) Missing or Invalid

US0208 (com.iso_Update) First Name (com.iso_OriginalFields/PersonName) Missing or Invalid

US0301 (Policy) Insurance Company (AgencyId) Missing or Invalid

US0302 (Policy) Policy Number (PolicyNumber) Missing or Invalid

US0303 (ClaimsOccurrence) Claim Number (ItemIdInfo/InsurerId) Missing or Invalid

US0304 (ClaimsOccurrence) Date of Loss (LossDt) Missing or Invalid

191

US0305 (com.iso_Update) Individual or Business Indicator Missing or Invalid In XML, this indicator is derived from the correct use of the <CommlName> vs. <PersonName> aggregates. If this error is received, then a ClaimsParty name has been coded incorrectly.

US0306 (com.iso_Update) Business Name (com.iso_OriginalFields/CommercialName) Missing or Invalid

US0307 (com.iso_Update) Last Name (com.iso_OriginalFields/PersonName) Missing or Invalid

US0308 (com.iso_Update) First Name (com.iso_OriginalFields/PersonName) Missing or Invalid

US0310 (AdjusterPartyInfo) Coverage Type (CoverageCd) Missing or Invalid

US0311 (ClaimsPayment) Claim Status (ClaimsPaymentCovInfo/ClaimStatusCd) Missing or Invalid

US0312 (ClaimsPayment) Estimate Amount (ClaimsPaymentCovInfo/PaymentAmt) Missing or Invalid

US0313 (ClaimsPayment) Reserve Amount (ClaimsPaymentCovInfo/PaymentAmt) Missing or Invalid

US0314 (ClaimsPayment) Amount Paid to Date (ClaimsPaymentCovInfo/PaymentAmt) Missing or Invalid

US0401 (Policy) Insurance Company (AgencyId) Missing or Invalid

US0402 (Policy) Policy Number (PolicyNumber) Missing or Invalid

US0403 (ClaimsOccurrence) Claim Number (ItemIdInfo/InsurerId) Missing or Invalid

US0404 (ClaimsOccurrence) Date of Loss (LossDt) Missing or Invalid

US0405 (com.iso_Update) Individual or Business Indicator Missing or Invalid In XML, this indicator is derived from the correct use of the <CommlName> vs. <PersonName> aggregates. If this error is received, then a ClaimsParty name has been coded incorrectly.

US0406 (ClaimsParty) Business Name (GeneralPartyInfo/NameInfo/CommlName) Missing or Invalid

US0407 (ClaimsParty) Last Name (GeneralPartyInfo/NameInfo/Surname) Missing or Invalid

US0408 (ClaimsParty) First Name (GeneralPartyInfo/NameInfo/GivenName) Missing or Invalid

US0410 (ClaimInvestigationAddRq) Action Indicator (SearchBasisCd) Missing or Invalid

US0501 (com.iso_Update) Original Insurance Company (com.iso_OriginalFields/ItemIdInfo/AgencyId) Missing or Invalid

US0502 (com.iso_Update) Policy Number (com.iso_OriginalFields/PolicyNumber) Missing or Invalid

US0503 (com.iso_Update) Claim Number (com.iso_OriginalFields/ItemIdInfo/InsurerId) Missing or Invalid

US0504 (com.iso_Update) Date of Loss (com.iso_OriginalFields/LossDt) Missing or Invalid

US0505 (Policy) New Insurance Company (MiscParty/ItemIdInfo/AgencyId) Missing or Invalid

US0506 (Policy) New Policy Number (PolicyNumber) Missing or Invalid

US0507 (ClaimsOccurrence) New Claim Number (ItemIdInfo/InsurerId) Missing or Invalid

US0508 (ClaimsOccurrence) New Date of Loss (LossDt) Missing or Invalid

US0601 (Policy) Insurance Company (AgencyId) Missing or Invalid

US0602 (Policy) Policy Number (PolicyNumber) Missing or Invalid

US0603 (ClaimsOccurrence) Claim Number (ItemIdInfo/InsurerId) Missing or Invalid

US0604 (ClaimsOccurrence) Date of Loss (LossDt) Missing or Invalid

US0605 (com.iso_Update) Individual or Business Indicator Missing or Invalid In XML, this indicator is derived from the correct use of the <CommlName> vs. <PersonName> aggregates. If this error is received, then a ClaimsParty name has been coded incorrectly.

US0606 (com.iso_Update) Business Name (com.iso_OriginalFields/CommercialName) Missing or Invalid

US0607 (com.iso_Update) Last Name (com.iso_OriginalFields/PersonName) Missing or Invalid

US0608 (com.iso_Update) First Name (com.iso_OriginalFields/PersonName) Missing or Invalid

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UF0001 Request would create a duplicate record. The system uses date of loss, insuring company code, policy number and claim number as unique identifiers. Those identifiers can only be added to the database one time for initial claims; otherwise a duplicate claim is rejected. (In XML terms, these are the <PolicyNumber>, <AgencyId>, <InsurerId>, and <LossDt>)

UF0002 Every claim must contain either a role of CI or IN. See Appendix D

UF0003 A coverage record is required for roles: CL, CP, CI, CD, CE If you submit any of these roles as described in Appendix D, there must be a UC01 (ClaimsInjuredInfo) for casualty, a UP01 or UP02 (PropertyLossInfo) for property, or a UV01 (AutoLossInfo) for vehicle claims referencing the Involved Party.

UF0004 A UP01 (PropertyLossInfo) can only exist for the roles of IN, CI, TN, PT, IP and ID. See Appendix D

UF0005 A UV01 (AutoLossInfo) can only exist for the roles of CL, CI, IN, CD, CP, ID and IP. See Appendix D

UF0006 A UC01 (ClaimsInjuredInfo) can only exist for the roles of CL, CP, CD, CI, IN, ID, IP, IE and CE. See Appendix D

UF0007 Every claim must have at least one coverage record. A coverage record is either a UC01 (ClaimsInjuredInfo), UP01 or UP02 (PropertyLossInfo), or UV01 (AutoLossInfo).

UF0008 Coverage/Loss combination is invalid. See Appendix B for valid combinations.

UF0009 Policy/Coverage combination is invalid See Appendix B for valid combinations.

UF0010 Initial claim not found When trying to update, replace or research a claim, the system looks to find the initiating claim with the same date of loss, insuring company code, policy, and claim number. If no initial claim is found, the records are rejected. (In XML terms, these are the <PolicyNumber>, <AgencyId>, <InsurerId>, and <LossDt>)

UF0011 Invalid message keys In XML, this error message can indicate that the XML Format itself is invalid or that it contains a character that is invalid in an XML string.

UF0012 UP01 (PropertyLossInfo/ClaimsSubjectInsuranceInfo) or UP02 (PropertyLossInfo/ItemInfo or PropertyLossInfo/Watercraft) can only exist once in a claim. Because General Property (fire, theft, other peril) and Boat or Mobile Equipment claims are first party reporting, they can only be reported once within a claim.

UF0013 Duplicate Coverage and Loss Combination Code. The claim contains the same ClaimsParty with the same coverage type with the same loss type more than once. On claims with multiple vehicles under a single claims party, VIN must also be different or it will be considered duplicate coverage/loss. See also UF0015 error code

UF0014 At least one stolen item must be reported On a property theft record, at least one item must be reported as stolen. (In XML, these are reported under PropertyLossInfo/ PropertySchedule. See Appendix A.)

UF0015 Auto theft loss can only be reported once per VIN

UF0016 Duplicate coverage/loss/VIN combination per person

UF0017 Claim exceeds 600 record limit

UF0018 Coverage NCVG cannot be submitted for policy type

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APPENDIX D – ROLE CODES

The following tables show the valid roles which can be sent using the ClaimsParty aggregate. Involved Party Role Codes (ClaimsPartyRoleCd - ISOUS)

The table below shows roles that may be reported as an individual involved party using the ClaimsPartyRoleCd code list. The table shows which role codes are acceptable in reporting by line of business (casualty, property, or auto). Roles that require a coverage aggregate (ClaimsInjuredInfo, PropertyLossInfo, or AutoLossInfo) are indicated by a “Y” in the Coverage Required column. The coverage aggregate should reference the ClaimsParty aggregate of the party making the claim against the policy. Definitions of these role codes follow the table. The table also indicates which roles are searchable in the different lines of business. The roles shaded gray are searchable in that line of business if they are followed by a coverage aggregate (described above). When sending one claim with a combination of lines of business, if any of the roles are searchable then they are searchable across the multiple lines. If a person qualifies for more than one role within a claim, for example, if they are an insured and an insured driver, please only report the person once within the claim using the more specific role such as insured driver. If the person is the insured and is also making a claim, use the role CI instead of reporting the person twice, once as an insured and once as a claimant.

Role Casualty Property Auto Coverage Required

CL Claimant Y N Y Y

CI Both Claimant and Insured Y Y Y Y

CD Claimant Driver Y N Y Y

CP Claimant Passenger Y N Y Y

CE Claimant Pedestrian Y N N Y

ID Insured Driver Y* Y Y N

IP Insured Passenger Y* Y Y N

IE Insured Employee Y N N N

IN Insured Y* Y Y N

OW Owner N N Y N

PT Partner N Y N N

TN Tenant N Y N N

WT Witness N N Y N

GM Guardian of Minor Y Y Y N

Casualty/Property/Auto Columns– Y=Acceptable in LOB, N=Not Acceptable in LOB Coverage Required Columns – Y=Required, N=Not Required Gray Shaded = Searchable in Line of Business * = Roles that are only searchable if name type is individual and coverage is provided. Other Party Role Codes (ClaimsPartyRole - ACORD)

The roles below are ACORD standard role types. When using these role codes to identify a party within a claim a codelistref is not used and the codes are case-sensitive. Alias – Alias ImpouundAgcy – Impounding Agency Appraiser – Appraiser PortOrigin – Port of Origin DeathMaster – Death Master RecoveringAgency – Recovering Agency Emergency – Emergency Agency SalvageBuyer – Salvage Buyer ImpoundFac – Impounding Facility

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Involved Party Role Code Definitions

Main Roles: Insured: Named insured on the policy. May be reported with coverage for first party claims (Property and Auto collision, comprehensive, and no fault), but coverage is not required for this party. In casualty claims, will only be searched if insured is an individual and coverage is provided. Claimant: Preferred role for all third party claimants, including non-named insured no-fault and medical payments claims. Coverage is required for this role. Both Claimant and Insured: Preferred role for Auto and Property first party claims, including no fault and auto medical payments claims, where party that has the claim is also the insured. Coverage is required for this role. Optional Roles Insured Driver: This role may be used to identify the location of insured within the insured vehicle. Coverage is not required, but can be assigned as Insured (above). In casualty claims, will only be searched if insured is an individual and coverage is provided. Insured Passenger: This role may be used to identify the location of passengers in insured vehicle. Could be named insured, or insured by definition. May be reported with coverage for first party claims (Auto medical payment and Auto no fault), but coverage is not required for this party. In casualty claims, will only be searched if insured is an individual and coverage is provided. Insured Employee: Identifies status of the insured in Commercial Auto losses. Generally, will identify driver in insured Commercial vehicle, and will have no coverage assigned. Coverage for first party no-fault or medical payments claims can be added. Coverage is not required for this party. (NOTE: This role should not be used for Workers’ Compensation claims.) Claimant Driver: This role may be used to identify the location of claimant in claimant vehicle or non-named insured in insured vehicle, for liability bodily injury or auto property damage claims. Coverage is required for this role. Claimant Passenger: This role may be used to identify the location of claimant in claimant vehicle or non-named insured in insured vehicle, for liability bodily injury or auto property damage claims. Coverage is required for this role. Claimant Pedestrian: Role for any pedestrian involved in a claim. Coverage is required for Auto claims. Owner: Identifies owner of the vehicle or property. This is informational only. Not the insured or claimant. There is no coverage assigned to this role, unless used to report owner of a salvaged vehicle. Partner: Identifies a party to the loss in Commercial Property claims, and for information in other claims. Partner role will be searched only in first party Property claims. Coverage is not required for this role. Tenant: Identifies occupant of building in Property claim, and for information in other claims. Tenant role will be searched only in first party Property claims. Coverage is not intended for, or required for this role. Witness or Guardian of Minor: Information only for all claims. These roles will not be searched, and coverage is not intended for these roles. A witness or guardian of minor should not have a claim. The role of beneficiary is reserved for future use.

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Service Provider Role Codes (ISOUS)

A service provider is anyone who has provided a service to an involved party due to the loss being reported. A service provider should be reported with its own <ClaimsParty> aggregate using the ClaimsPartyRoleCd values below as well as a <ClaimsPartyRelationship Aggregate> that references both the involved party and the service provider and their roles in the claim. The roles shaded gray are searchable within the Property line of business. The roles in italics may have <com.iso_1stDoctorDt> reported in their information. BE – Body Shop Employee MD – Medical Doctor BL – Billing Company ME – Emergency Care Facility BO – Body Shop Manager MF – Hospital BS – Body Shop MG – Radiologist CO – Corporate Officer MH – Medical Clinic/Hospital (for better data quality CT – Contractor please try to use roles MF, ME or MK instead of MH) EM – Employer MK – Medical Clinic FM – First Mortgagee ML – Licensed Vocational/Practical Nurse IA – Independent Appraiser MM – Other Medical Personnel IB – Agent/Broker MN – Nurse II – Independent Adjuster MO – Other Doctor IO – Other Insurance Personnel MR – Laboratory IR – Staff Appraiser MS – Dentist IS – Staff Adjuster MT – Physical Therapist IY – Insurance Employee MX – X-Ray Lab LC – Claimant Lawyer MY – Other Medical Provider LI – Insured Lawyer MZ – Office Administrator LM – Law Office Manager NP – Other Non-Professional LO – Law Office OP – Other Professional LP – Loss Payee OS – Osteopath LR – Paralegal PA – Public Adjuster LS – Lawyer for CMS Claimant PH – Pharmacy LW – Lawyer – Other PS – Psychologist MA – Physician’s Assistant SM – Second Mortgagee MC – Chiropractor TW – Towing Company Additional Claimant Role Codes for Medicare Section 111 Reporting

The additional claimant role codes provided below are intended for Medicare Section 111 Reporting Only. Each additional claimant should be reported with its own ClaimsParty aggregate using the ClaimsPartyRoleCd codelist values below as well as a ClaimsPartyRelationship Aggregate that references both the claims party and the additional claimant and their roles in the claim. Up to four Additional Claimants may be reported per ClaimsParty, each may have its own legal representative which in turn can have its own alias information. NOTE – more than 4 Additional Claimants may be sent, but only the first four will be stored in the system. ES – Estate FA – Family OC – Other Claimant

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Legal Representative Role Codes for Medicare Section 111 Reporting

The legal representative role codes provided below are intended for Medicare Section 111 Reporting Only. These roles are in addition to the legal representative roles (LC, LI, LM, LO, LR, or LW) listed with the Service Providers above. Each representative should be reported with its own <ClaimsParty> aggregate using the ClaimsPartyRoleCd codelist values below as well as a <ClaimsPartyRelationship Aggregate> that references both the <ClaimsParty> for either the CMS Claimant or the Additional Claimant for whom the representative provided services and the representative and their roles in the claim. LS – Lawyer for CMS Claimant (used for reporting Representative) GU – Guardian (used for reporting Representative) OR – Other Representative (used for reporting Representative) PW – Power of Attorney (used for reporting of Representative) NOTE REGARDING LEGAL REPRESENTATIVES AND CMS MEDICARE REPORTING - Claims with Attorney Roles (GU, LC, LI, LM, LO, LR, LS, LW, OR, or PW) associated with an Injured Party reported on or after 1/1/11 are required to have the following fields on the Legal Representative <ClaimsParty> aggregate reported to CMS Medicare: CMS Medicare Fields for Injured Party Attorney Service Providers, per CMS requirements at the time of publishing.

Field Name CMS Usage XML Tag Name CMS Field Description

Business Name Optional <CommercialName> CMS Field #70 for Attorney Roles (LC, LI, LM, LO, LR, LW)

Last Name Required <Surname> CMS Required Field #65 if Injured Party has a representative (for roles indicated in Role description above).

First Name Required <GivenName> CMS Required Field #66 if Injured Party has a representative (for roles indicated in Role description above).

SSN Optional <TaxId> CMS Field #68 - if Injured Party has a representative which is an individual

TIN Optional <TaxId> CMS Field #68 - if Injured Party has a representative which is an business

Address Info Line 1 Required <Addr1> CMS Field #69 – Street Number and Name. If no US address is available, empty tag should be sent with “FC” in the <StateProvCd>

Address Info Line 2 Optional <Addr2> CMS Field #70 – Other address info, such as suite number.

City Required <City> CMS Field #71 – If no US address is available, empty tag should be sent with “FC” in the <StateProvCd>

State Required <StateProvCd> CMS Field #72 – If no US address is available, supply “FC.” The District of Columbia, American Samoa, Guam, Puerto Rico, and the US Virgin Islands are considered to have US addresses.

Postal Code Required <PostalCode> 9 digits, CMS Field #73 and 74

Telephone Required <Communications/ PhoneInfo/ PhoneTypeCd “Phone”/ CommunicationUseCd “Home”/ PhoneNumber>

CMS Field #75 and 76 - Only one phone number plus extension is submitted to CMS. There is no distinction of “Home” or “Business”; “Phone” or “Cell”. If no US phone number is available, fill with zeroes and supply “FC” in the <StateProvCd>

Role Code Required <ClaimsPartyRoleCd>

Uses codelistref

CMS Field #64 for Attorney Roles (LC, LI, LM, LO, LR, LW), Guardian (GU) and/or Power of Attorney (PW).

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APPENDIX E – CLAIMS PAYMENT AND STATUS REPORTING RULES

Claims Payment Reporting Rules

Below are general rules for sending ClaimsPayment Information based on the type of payment being reported and the Line of Business (Casualty, Auto, Boat, Mobile Equipment, or General Property) that is being reported. Note - If more than one payment amount is entered per Payment Type for a single coverage/loss, the first amount listed on the file is taken and the other(s) ignored. Estimated Loss Amount – This amount is reported with the tag “ProbableIncurredAmt” as per line of business below:

Casualty, Auto, Boat, or Mobile Equipment – ClaimsOccurrence/ ProbableIncurredAmt. Beginning with XML Manual version 5.2, an idref has been added to this element so that it may be repeated with various dollar amounts and applied to individual coverages. Those programmed for prior versions may report this field once per claim with the dollar amount entered added to each casualty and auto coverage listed on the claim. Property – PropertyLossInfo/ ClaimsSubjectInsuranceInfo/ SubjectInsuranceCd (uses RISK code list to identify property coverage to apply amount to.) Dollar amount is entered into PropertyLossInfo/ ClaimsSubjectInsuranceInfo/ ProbableIncurredAmt. In property, this element may be reported once for each coverage under individual ClaimsSubjectInsuranceInfo aggregates.

Reserve Amount – This amount is reported ClaimsPayment/ PaymentTypeCd with the ACORD value of “LossResv” as per line of business below:

Casualty – ClaimInvestigationAddRq/ ClaimsPayment is created with idref pointing to ClaimsInjuredInfo and ClaimsPartyRef pointing to the appropriate ClaimsParty. ClaimsPayment/ PaymentTypeCd=”LossResv” and dollar amount is entered into TotalPaymentAmt/ Amt. Auto - ClaimInvestigationAddRq/ ClaimsPayment is created with idref pointing to AutoLossInfo and ClaimsPartyRef pointing to the appropriate ClaimsParty. ClaimsPayment/ PaymentTypeCd=”LossResv” and dollar amount is entered into TotalPaymentAmt/ Amt. Property – PropertyLossInfo/ ClaimsSubjectInsuranceInfo/ SubjectInsuranceCd (uses RISK code list to identify property coverage to apply amount to.) PropertyLossInfo/ ClaimsSubjectInsuranceInfo/ ClaimsPayment/ PaymentTypeCd=LossResv. Dollar amount is entered into ClaimsPayment/ ClaimsPaymentCovInfo/ PaymentAmt/ Amt. Boat or Mobile Equipment - ClaimInvestigationAddRq/ ClaimsPayment is created with idref pointing to PropertyLossInfo and ClaimsPartyRef pointing to the appropriate ClaimsParty. ClaimsPayment/ PaymentTypeCd=”LossResv” and dollar amount is entered into TotalPaymentAmt/ Amt.

Settlement Amount/Paid Amount – This amount is reported as per line of business below: Casualty – ClaimInvestigationAddRq/ ClaimsPayment is created with idref pointing to ClaimsInjuredInfo and ClaimsPartyRef pointing to the appropriate ClaimsParty. ClaimsPayment with dollar amount entered into TotalPaymentAmt/ Amt. No PaymentTypeCd is used for Settlement amount in casualty. This code is assumed. Coverage must be submitted to apply to the correct coverage using ClaimsPayment/ ClaimsPaymentCovInfo/ CoverageCd (uses CoverageCd code list – Appendix B). Auto - ClaimInvestigationAddRq/ ClaimsPayment is created with idref pointing to AutoLossInfo and ClaimsPartyRef pointing to the appropriate ClaimsParty. ClaimsPayment with dollar amount entered into TotalPaymentAmt/ Amt. No PaymentTypeCd is used for Settlement amount in auto. This code is assumed. Coverage must be submitted to apply to the correct coverage using ClaimsPayment/ ClaimsPaymentCovInfo/ CoverageCd (uses CoverageCd code list – Appendix B).

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Property – PropertyLossInfo/ ClaimsSubjectInsuranceInfo/ SubjectInsuranceCd (uses RISK code list to identify property coverage to apply amount to.) PropertyLossInfo/ ClaimsSubjectInsuranceInfo/ ClaimsPayment/ PaymentTypeCd=Payment. Dollar amount is entered into ClaimsPayment/ ClaimsPaymentCovInfo/ PaymentAmt/ Amt. Boat or Mobile Equipment - Auto - ClaimInvestigationAddRq/ ClaimsPayment is created with idref pointing to PropertyLossInfo and ClaimsPartyRef pointing to the appropriate ClaimsParty. ClaimsPayment with dollar amount entered into TotalPaymentAmt/ Amt. No PaymentTypeCd is used for Settlement amount in auto. This code is assumed. Coverage must be submitted to apply to the correct coverage using ClaimsPayment/ ClaimsPaymentCovInfo/ CoverageCd (uses CoverageCd code list – Appendix B).

Policy Amount – General Property Only. PropertyLossInfo/ ClaimsSubjectInsuranceInfo/ SubjectInsuranceCd (uses RISK code list to identify property coverage to apply amount to.) Dollar amount is entered into PropertyLossInfo/ ClaimsSubjectInsuranceInfo/ InsuranceAmt. In property, this element may be reported once for each coverage under individual ClaimsSubjectInsuranceInfo aggregates. First Claims Payment – Can be reported once per claim. This is the DATE of the First Claims Payment, not the amount. This is reported in its own ClaimsPayment aggregate without any dollar amount. ClaimsPayment/PaymentTypeCd=FCP and ClaimsPayment/PaymentDt = date of first claims payment. Note – In Property, this is reported in its own ClaimsPayment aggregate AFTER the closing tag of the PropertyLossInfo aggregate and requires an ItemRef and ClaimsParty Ref. Paid Amount for Indemnity – This amount can only be reported for a Casualty claim. It is intended to report the indemnity portion of the total paid amount (see below) on workers’ compensation claims. This amount is a Request Only field. It is reported as ClaimsPayment (where idref points to ClaimsInjuredInfo and ClaimsPartyRef points to the ClaimsParty)/ PaymentTypeCd=IndemnityPd and ClaimsPayment/ TotalPaymentAmt/ Amt is the dollar amount paid. Paid Amount for Medical Bills – This amount can only be reported for a Casualty claim. It is intended to report the medical bills portion of the total paid amount (see below) on workers’ compensation claims. This amount is a Request Only field. It is reported as ClaimsPayment (where idref points to ClaimsInjuredInfo and ClaimsPartyRef points to the ClaimsParty)/ PaymentTypeCd=MedicalBillsPd and ClaimsPayment/ TotalPaymentAmt/ Amt is the dollar amount paid. Total Paid Amount for Loss - This amount can only be reported for a Casualty claim. It is intended to report the total paid amount on casualty claims. (If BI claim, report settlement amount, If PIP or WC claim, report total paid – excluding expenses.) This amount is a Request Only field. It is reported as ClaimsPayment (where idref points to ClaimsInjuredInfo and ClaimsPartyRef points to the ClaimsParty)/ PaymentTypeCd=MedicalBillsPd and ClaimsPayment/ TotalPaymentAmt/ Amt is the dollar amount paid.

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Claims Status Reporting Rules

Below are general rules for how to submit a ClaimStatusCd based on the type of payment being reported and the Line of Business (Casualty, Auto, Boat, Mobile Equipment, or General Property) that is being reported. The system default for all claim types is a claim status of “Open”. Casualty, Auto, Boat and Mobile Equipment claims - ClaimStatusCd is submitted as part of the ClaimInvestigationAddRq/ ClaimsPayment/ ClaimsPaymentCovInfo. It must be sent WITH CoverageCd and WITHOUT PaymentTypeCd. If a Settlement Amount (using TotalPaymentAmt) exists on the claim, then ClaimStatusCd should be sent in the same ClaimsPayment aggregate. See example below:

<ClaimsPayment idref="ClaimsInjury-01" ClaimsPartyRef="ClaimsParty-02"> <ClaimsPaymentCovInfo> <CoverageCd codelistref="CoverageCdList">MPAY</CoverageCd> <ClaimStatusCd codelistref="ClaimStatusCdList">C</ClaimStatusCd> </ClaimsPaymentCovInfo> <TotalPaymentAmt> <Amt>2000</Amt> </TotalPaymentAmt> </ClaimsPayment>

If no Settlement Amount exists on the claim, then the ClaimStatusCd can be sent by itself. <ClaimsPayment idref="ClaimsInjury-01" ClaimsPartyRef="ClaimsParty-02"> <ClaimsPaymentCovInfo> <CoverageCd codelistref="CoverageCdList">MPAY</CoverageCd> <ClaimStatusCd codelistref="ClaimStatusCdList">C</ClaimStatusCd> </ClaimsPaymentCovInfo> </ClaimsPayment>

Property - ClaimStatusCd is submitted as part of the PropertyLossInfo/ ClaimsPayment/ ClaimsPaymentCovInfo. It does not require CoverageCd. It can be sent with any PaymentTypeCd and TotalPaymentAmt. If multiple ClaimStatusCd elements are submitted on a single Request, the first ClaimStatusCd submitted on the Request will be the one stored. <ClaimsPayment> <ClaimsPaymentCovInfo> <ClaimStatusCd codelistref="ClaimStatusCdList">C</ClaimStatusCd> </ClaimsPaymentCovInfo> </ClaimsPayment>

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WHO TO CALL

If you are getting started and have questions concerning any item in this document, please contact ISO ClaimSearch using one of the following methods:

ISO ClaimSearch Customer Support Office (800) 888-4476 NJSupport@iso.com 545 Washington Boulevard, 22-8

Jersey City, NJ 07310-1686 Medicare Secondary Payer Reporting Service Help Desk ClaimSearchMSP@iso.com

Note - This is for questions and troubleshooting specific to the Medicare Secondary Payer Reporting Service. It is not for programming questions; please direct those questions to your Testing Representative below.

If your company is already in development, testing, or production with XML Format for ClaimSearch Claims Reporting, please contact your assigned ISO ClaimSearch Testing Representative below with any questions regarding programming, testing results, coordinating the move to production, or production support:

Matthew Scarfuto 201-469-3093 mscarfuto@verisk.com Nancy Chayka 201-469-3401 nchayka@iso.com Erik Hanley 201-469-3076 ehanley@verisk.com Anita Polk 201-469-3083 avpolk@iso.com Katya Stambler 201-469-3075 kstambler@verisk.com Brian Thompson 201-469-3084 bthompson@iso.com

ISO ClaimSearch Database Development Group If your assigned representative is out of the office and you require assistance before their return, please contact the group email address: ClaimSearchDatabaseDevelopment@iso.com

As we strive to meet the needs of all customers, ISO ClaimSearch staff will make every effort to respond to requests within 1 business day, but may take up to 3 business days for investigation, troubleshooting, and the processing of test files as necessary. Please keep this in mind as you contact ISO ClaimSearch.

If you believe you may be having a COMMUNICATIONS issue, such as not being able to send or receive XML transmissions, please contact:

ISO ClaimSearch Technical Support (800) 888-4476 or TechSuppIncidents@iso.com Specify your AgencyId and whether this is the test or production environment.

(Business Hours: 7:00 a.m. - 9:00 p.m., Monday - Friday, ET) Note – Technical Support does not have the ability to verify individual claims, only general communication issues. If you need information on specific claims, please contact your Testing Representative listed above.

If you have questions regarding establishing XML communications, please contact:

Tricia King 201-469-3098 tmking@iso.com Mark Cornago 201-469-3082 mcornago@iso.com Rita Plavnik 201-469-3099 mplavnik@iso.com