Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 162 - ELECTRONIC DATA INTERCHANGE; PROOF OF COVERAGE › Section 436-162-0005 - General Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
For the purpose of these rules:
(1) "Director" means the director of the
			 Department of Consumer and Business Services or the director's designee for the
			 matter.
(2) "Division" means the
			 Workers' Compensation Division of the Department of Consumer and Business
			 Services.
(3) "Electronic data
			 interchange" or "EDI" means a computer to computer exchange of information in a
			 standardized electronic format.
(4) "Electronic record" means information
			 created, generated, sent, communicated, received, or stored by electronic
			 means.
(5) "Establishing document"
			 means a transaction that reports coverage for one or more entities.
			 Establishing document types are coverage notice/binders, new policies,
			 rewrite/reissue transactions, renewals, reinstatements, add jurisdiction
			 endorsements, or add employer/location endorsements.
(6) "Exclude (X)" means the data element must
			 not be sent or cannot be sent.
(7)
			 "Expected (E)" means the data element is expected on the transaction, but the
			 transaction will be accepted with errors should it fail any edit.
(8) "Fatal Technical (F)" means the data
			 element must be sent.
(9) "Fatal
			 Technical/Conditional (FT)" means the data element must be sent when certain
			 conditions are present.
(10)
			 "FEIN" means the federal employer identification number or other federal
			 reporting number used by the Internal Revenue Service (IRS) to identify a
			 business entity and by the insurer, insured, or employer for federal tax
			 reporting purposes.
(11) "Header
			 record" means the record that precedes each transmission for the purpose of
			 identifying a sender, the date and time of the transmission, and the
			 transaction set within the transmission.
(12) "IAIABC" means the International
			 Association of Industrial Accident Boards and Commissions, a professional trade
			 association consisting of state workers' compensation regulators and insurance
			 and corporate agency representatives (www.iaiabc.org [File Link Not
			 Available]).
(13) "If
			 Applicable/Available with Item Accept if Invalid (IA)" means the data may or
			 may not be populated. If present, may be edited for valid value or format. The
			 division may or may not return an error on validity edits.
(14) "Industry code" means the code that
			 indicates the nature of the employer's business as published in the North
			 American Industrial Classification System (NAICS) manual, available in print
			 and on CD-ROM from the National Technical Information Service (NTIS)
			 http://www.ntis.gov/products/naics.aspx [File Link Not Available]. NAICS codes
			 may also be viewed at the U.S. Census Bureau webpage
			 (http://www.census.gov/eos/www/naics/ [File Link Not Available]).
(15) "Information" means data, text, images,
			 sounds, codes, computer programs, software, databases, or the like.
(16) "Insurer" means the State Accident
			 Insurance Fund Corporation or an insurer authorized under ORS chapter 731 to
			 transact workers' compensation insurance in Oregon.
(17) "Mandatory (M)" means the data element
			 must be sent. If the data element is omitted or submitted in a format the
			 division is unable to process, the transaction will be rejected.
(18) "Mandatory/Conditional (MC)" means the
			 data element must be sent when certain conditions are present.
(19) "Not Applicable (NA)" means the data
			 element is not required to be sent, but it may be sent. If it is sent, edits
			 may be applied, but unsuccessful edits will not cause the transaction to be
			 rejected.
(20) "Proof of coverage"
			 means an electronic record or set of records identifying an insurer as
			 providing workers' compensation coverage for a specific employer.
(21) "Record" means electronic record.
(22) "Restricted (R)" means the
			 data element value will not be accepted if a stated condition exists.
(23) "Sender" means the vendor or
			 insurer authorized to send EDI transactions to the division.
(24) "Trailer record" means the record that
			 designates the end of a transmission and provides a count of transactions
			 contained within the transmission, not including the header and trailer
			 records.
(25) "Transaction" means
			 a set of EDI records, defined according to standards in OAR
			 436-162-0004(1).
(26) "Transaction reason code"
			 means the two-digit code identifying the type of transaction and why it was
			 sent (e.g., 54, adding an employer location).
(27) "Transaction set purpose code" means the
			 code identifying whether the transaction is an original, change, or replacement
			 transaction (e.g., 00, original).
(28) "Transaction set type code" means the
			 code identifying the purpose of individual records within the transaction
			 (e.g., 42, canceled by insured).
(29) "Transmission" means a defined set of
			 transactions, including both header and trailer records sent to the division or
			 sender by EDI.
(30) "Triplicate
			 code" means the series of three two-digit codes that define the specific
			 purpose of individual records in a proof of coverage transmission in this
			 order: transaction set purpose code, transaction set type code, and transaction
			 reason code.
(31) "Vendor" means
			 an agent identified by an insurer to submit transmissions to the division on
			 behalf of the insurer.
Stat. Auth: ORS
				  656.264 &
				  656.726(4)
Stats. Implemented: ORS
				  656.419,
				  656.423 &
				  656.427