Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 160 - GENERAL PROVISIONS › Section 436-160-0005 - General Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
For the purpose of these rules, unless it conflicts with
				statute or rule:
(1) "ANSI" means the
			 American National Standards Institute.
(2) "ASC X12" means the Accredited Standards
			 Committee chartered by the American National Standards Institute
			 (http://www.x12.org/x12org/index.cfm [File Link Not Available]).
(3) "Director" means the Director of the
			 Department of Consumer and Business Services or the director's designee for the
			 matter.
(4) "Division" means the
			 Workers' Compensation Division of the Department of Consumer and Business
			 Services.
(5) "Electronic data
			 interchange" or "EDI" means a computer to computer exchange of information in a
			 standardized electronic format.
(6) "Electronic record" means information
			 created, generated, sent, communicated, received, or stored by electronic
			 means.
(7) "Exclude (not
			 applicable to the transaction)" means the data element must not be sent or
			 cannot be sent.
(8) "Fatal
			 Technical" means the transaction set or item structurally requires the data
			 element.
(9) "FEIN" means the
			 federal employer identification number or other federal reporting number used
			 by the insurer, insured, or employer for federal tax reporting purposes.
(10) "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.
(11) "Health Care
			 Provider" has the same meaning as "medical provider," under OAR
			 436-010-0005(28).
(12) "IAIABC" means the
			 International Association of Industrial Accident Boards and Commissions, a
			 professional trade association comprised of state workers' compensation
			 regulators and insurance representatives (www.iaiabc.org [File Link Not
			 Available]).
(13) "If
			 Applicable/Available with Item Accept if Invalid" means the data element must
			 be sent if appropriate for the item record. Even if the item record has an
			 invalid value, the transaction set or item record will not be rejected.
(14) "If Applicable/Available with
			 Item Reject if Invalid" means the data element must be sent if appropriate for
			 the item record. If the item record has an invalid value, then the transaction
			 set or item record will be rejected.
(15) "Information" means data, text, images,
			 sounds, codes, computer programs, software, databases, or the like.
(16) "Insurer" means the State Accident
			 Insurance Fund Corporation, an insurer authorized under ORS chapter 731 to
			 transact workers' compensation insurance in Oregon, an assigned claims agent
			 selected by the director under ORS
			 656.054, or a self-insured
			 employer.
(17) "Mandatory data
			 element" means an element that will cause a rejection of a transaction if the
			 data element is omitted or submitted in an invalid format, or with an improper
			 value.
(18) "Mandatory
			 Conditional" means the data element is required when certain conditions are
			 present.
(19) "Medical Bill" means
			 a statement of charges for medical services, specified as "compensable medical
			 services," under ORS 656.245.
(20) "Not Applicable" means the data element
			 is not relevant, appropriate, or doesn't apply, although if present with an
			 improper value will not cause a rejection of a transaction.
(21) "Record" means electronic record.
(22) "Trading partner" means the
			 entity sending electronic data interchange (EDI) transactions to the division.
			 Trading partners may include vendors or insurers.
(23) "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.
(24) "Transaction" means
			 a set of EDI records, defined according to standards in OAR
			 436-160-0004.
(25) "Transmission" means a defined set of
			 transactions, including both header and trailer records to be sent to the
			 division or sender by EDI.
Stat. Auth.: ORS
				  656.264 &
				  656.726(4)
Stats. Implemented: ORS
				  84.004 &
				  656.264