N4 – MEMBER CITY, STATE, ZIP CODE X12 Segment Name: Geographic Location X12 Purpose: To specify the geographic place of the named party Loop: 2100A – MEMBER NAME Usage: Required TR3 Example: N4*BEAVERTON*OR*97007~ Element Detail: Ref Name Type Min/Max Usage N401 City Name AN 2/30 Required Free-form text for city name N402 State or Province Code ID 2/2 Situational Code (Standard State/Province) as defined by appropriate government agency REQUIRED when address is in USA, including its territories, or Canada N403 Postal Code ID 3/15 Situational Code defining international postal zone code excluding punctuation and blanks REQUIRED when address is in USA, including its territories, or Canada N404 Country Code ID 2/3 Situational Code identifying the country REQUIRED when address is outside of the USA N405 Location Qualifier ID 1/2 Situational Code identifying type of location Code Definition 60 Area CY County/Parish N406 Location Identifier AN 1/30 Situational Code which identifies a specific location N407 Country Subdivision Code ID 1/3 Situational Code identifying the country subdivision Use the country subdivision codes from Part 2 of ISO 3166 WDG Requirements: N401 is required and should contain <City Name> N402 is required and should contain <State> N403 is required and should contain <Zip Code> N404 is situational and should contain <Country Code> N405 is situational (follow guide above – no WDG requirement) N406 is situational (follow guide above – no WDG requirement) N407 is situational (follow guide above – no WDG requirement)
EC – EMPLOYMENT CLASS X12 Segment Name: Employment Class X12 Purpose: To provide class of employment information Loop: 2100A – MEMBER NAME Usage: Situational TR3 Example: EC*04*06*07~ Element Detail: Ref Name Type Min/Max Usage EC01 Employment Class Code ID 2/3 Required Code indicating category of employee Code Definition 01 Union Non-Union Executive Non-Executive Management Non-Management Hourly Salaried Administrative Non-Administrative Exempt Non-Exempt 17 Highly Compensated 18 Key-Employee 19 Bargaining 20 Non-Bargaining 21 Owner 22 President 23 Vice President EC02 Employment Class Code ID 2/3 Situational Code indicating category of employee (same codes as listed above) EC03 Employment Class Code ID 2/3 Situational Code indicating category of employee (same codes as listed above) EC04 Percentage as Decimal R 1/10 Not Used EC05 Information Status Code ID 1/1 Not Used EC06 Occupation Code ID 24/6 Not Used WDG Requirements: Segment not required, but if used follow guide above (no WDG requirements)
NM105 is situational and should contain <Prior Incorrect Middle Initial or Middle Name> NM106 is situational (follow guide above – no WDG requirement) NM107 is situational (follow guide above – no WDG requirement) NM108 is only required if supplying the member’s SSN in NM109 and should then contain”34” Note: please DO NOT use “ZZ” in NM108 as the value in NM109 will then conflict with the WDG system generated ID# for each member NM109 is situational and should contain <Prior Incorrect SSN >Note: please DO NOT send invalid or duplicate SSN’s for members. Members will not load into the system with duplicate or invalid SSN’s NM110 is NOT USED NM111 is NOT USED NM112 is NOT USED DMG – INCORRECT MEMBER DEMOGRAPHICS X12 Segment Name: Demographic Information X12 Purpose: To supply demographic information Loop: 2100B – INCORRECT MEMBER NAME Usage: Situational TR3 Example: DMG*D8*19450915*M~ Element Detail: Ref Name Type Min/Max Usage DMG01 Date Time Period Format Qualifier ID 2/3 Situational Code indicating the date format, time format, or date & time format Code Definition D8 Date Expressed in Format CCYYMMDD DMG02 Date Time Period AN 1/36 Situational Prior Incorrect Insured Birth Date DMG03 Gender Code ID 1/1 Situational Prior Incorrect Insured Gender Code Code Definition F Female M Male U Unknown DMG04 Marital Status Code ID 1/1 Situational Prior Incorrect Insured Marital Status Code DMG05 Composite Race or Ethnicity Info Situational Prior Incorrect Race or Ethnicity Info Race or Ethnicity information is reported in either DMG05-1 or DMG05-2 and DMG05-3 DMG05-1 Race or Ethnicity Code ID 1/1 Situational Code indicating the racial or ethnic background of a person Ref Name Type Min/Max Usage DMG05-2 Code List Qualifier Code ID 1/3 Situational Code identifying a specific industry code list Code Definition RET Classification of Race or Ethnicity DMG05-3 Industry Code AN 1/30 Situational