Form 1 OCSE Insurance Match Standard Input File Record

Information Comparision with Insurance Data

2017_09_14_Insurance_Match_Standard_Input_File_Record(SIF)_0970-0342_FINAL

Insurance Match File: Monthly Reporting Electronically

OMB: 0970-0342

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OMB Control Number: 0970-0342

Part A: OCSE Insurance Match Standard Input File Record Expiration Date: XX/XX/20XX



  1. OCSE Insurance Match Standard Input File Record

The IM SIF is a standard, fixed-format layout used for sending insurance claim data to us. This section explains the SIF record layout, including field definitions and required fields. Although all of the data elements are helpful to state child support agencies, most of the elements are not required. If the information is not available, you must fill the fields with spaces.

Chart A-1 includes the following information:

Field Name Identifies the name of the field.

Location Identifies the position of the field in the record.

Length Identifies the size of the field in bytes.

A/N Designates the type of field: alphabetic (A), numeric (N), or alphanumeric (A/N).

Comments Provides a description of the field, as well as valid values.

Chart A-1: OCSE Insurance Match Standard Input File Record

Field Name

Location

Length

A/N

Comments

Record Identifier

1-2

2

A/N

The characters ‘IM.’

Insurer Processing Date

3-10

8

A/N

The date you created or updated the record in your system. The date is in the CCYYMMDD format.

Insurer Provided SSN

11-19

9

A/N

The claimant’s SSN you have on file. If you cannot provide the SSN, you must provide the Claimant Birth Date or Claimant Address fields.

Obligor SSN

20-28

9

A/N

Matching partners must use the SSN we provided in the Debtor file.

Obligor Last Name

29-48

20

A/N

Matching partners must use the last name we provided in the Debtor file.

Obligor First Name

49-63

15

A/N

Matching partners must use the first name we provided in the Debtor file.

Insurer Identifier

64-72

9

A/N

Your Federal Employer Identification Number.

Insurer Name

73-117

45

A/N

The insurer who keeps the insurance claim and to whom the state is directed to send the insurance intercept request for processing. This field is required.

Insurer Address Line 1

118-157

40

A/N

The insurer’s street address where the state sends the insurance intercept request. This field is required unless Insurer Address Line 2 is provided.

Insurer Address Line 2

158-197

40

A/N

The insurer’s address information where the state sends the insurance intercept request.

Insurer Address City Name

198-227

30

A/N

The insurer’s city where the state sends the insurance intercept request. This field is required.

Insurer Address State Code

228-229

2

A/N

The state alphabetic code where the state sends the insurance intercept request. This field is required.

Insurer Address Zip Code

230-244

15

A/N

The insurer’s ZIP Code. U.S. ZIP Codes must be 5 or 9 characters. Foreign ZIP Codes may be up to 15 characters.

Insurer Address Foreign Country Indicator

245

1

A/N

If the insurer’s address is in a foreign country, enter a numeric ‘1.’

Insurer Address Foreign Country Name

246-270

25

A/N

If the “Insurer Address Foreign Country Indicator” is a ‘1,’ enter the name of the foreign country.

Insurer Contact Last Name

271-300

30

A/N

Your contact’s last name.

Insurer Contact First Name

301-320

20

A/N

Your contact’s first name.

Insurer Contact Phone Number

321-330

10

A/N

Your contact’s phone number.

Insurer Contact Phone Extension Number

331-336

6

A/N

Your contact’s phone number extension.

Insurer Contact Fax Number

337-346

10

A/N

Your contact’s fax number.

Insurer Contact Email

347-386

40

A/N

Your contact’s e-mail address.

Insurer Claim Number

387-416

30

A/N

The unique claim number you assigned.

Insurance Product Claim Type

417-418

2

A/N

The type of claim in this record. Valid values are:

00 – Life

01 – Automobile

02 – Automobile – No fault

03 – Automobile – Medical

04 – Property liability

05 – Workers’ compensation

06 – Personal injury

07 – General liability

08 – Homeowners liability

09 – Medical premise/owner’s policy

10 – Product liability

11 – Slip, trip, and fall

12 – Property damage

13 – Unknown

14 – Disability

15 – Annuity

16 – Policy surrender

17 – Mutual fund

18 – Unemployment

19 – Dividend withdrawals

99 – Other

Insurance Claim State Code

419-420

2

A/N

The state alphabetic code where the insurance loss occurred.

Insurance Claim Loss Date

421-428

8

A/N

The insurance claim or injury date. The date is in the CCYYMMDD format.

Insurance Claim Beneficiary Indicator

429

1

A/N

Specify whether a beneficiary is associated with this life insurance claim. Valid values are:

Y – Yes. A beneficiary is associated with this life insurance claim.

N – No. A beneficiary is not associated with this life insurance claim.

Insurance Claim Reported Date

430-437

8

A/N

The date the claimant reported the claim to you. The date is in the CCYYMMDD format.

Insurance Claim Status Code

438

1

A/N

The status of the claim. Valid values are:

0 – Open

1 – Closed

Insurance Claim Payout Frequency Code

439

1

A/N

Indicate the frequency of the payouts. Valid values are:

1 – One-time

2 – Weekly

3 – Biweekly

4 – Monthly

5 – Quarterly

6 – Annually

7 – Other

Obligor Match Code

440-441

2

A/N

Claim submitters fill this field with spaces.

Matching partners enter the result of the match performed by comparing the obligor identifying information we provided against your data. Valid values are:

00 – Name and Address

01 – Name and DOB

02 – Name and SSN

03 – SSN

04 – SSN and Address

05 – SSN and DOB

06 – SSN, Name, and Address

07 – SSN, Name, and DOB

08 – SSN, Address, and DOB

09 – SSN, Name, Address, and DOB

10 – Name, Address, and DOB

Claimant Last Name

442-471

30

A/N

The claimant’s last name you have on file.

This is a required field.

Claimant First Name

472-491

20

A/N

The claimant’s first name you have on file.

This is a required field.

Claimant Middle Name

492-507

16

A/N

The claimant’s middle name you have on file.

Claimant ITIN Number

508-516

9

A/N

The claimant’s Individual Taxpayer Identification Number (ITIN) when there is no SSN.

Claimant Birth Date

517-524

8

A/N

The claimant’s date of birth you have on file. The date is in the CCYYMMDD format.

If the “Insurer Provided SSN” is not included, then this field or the Claimant Address fields are required.

Claimant Gender Code

525

1

A/N

The claimant’s gender you have on file. Valid values are:

F – Female

M – Male

Claimant Home Phone Number

526-535

10

A/N

The claimant’s home phone number.

Claimant Business Phone Number

536-545

10

A/N

The claimant’s business phone number.

Claimant Business Phone Extension Number

546-551

6

A/N

The claimant’s business phone number extension.

Claimant Cell Phone Number

552-561

10

A/N

The claimant’s cell phone number.

Claimant Driver

License Number

562-581

20

A/N

The claimant’s driver’s license number.

Claimant Driver License State Code

582-583

2

A/N

The state alphabetic code that issued the insurance claimant’s driver’s license.

Claimant Occupation

584-623

40

A/N

The claimant’s occupation.

Claimant Professional License Number

624-638

15

A/N

The claimant’s professional license number.

Claimant Address Line 1

639-678

40

A/N

The claimant’s street address.

If the insurer-provided SSN is not included, then the claimant’s address fields or the “Claimant Birth Date” is required.

Claimant Address Line 2

679-718

40

A/N

The claimant’s address information.

Claimant Address City Name

719-748

30

A/N

The claimant’s city.

Claimant Address State Code

749-750

2

A/N

The state alphabetic code for the claimant’s address.

Claimant Address Zip Code

751-765

15

A/N

The ZIP Code for the claimant’s address. U.S. ZIP Codes must be 5 or 9 characters. Foreign ZIP Codes may be up to 15 characters.

Claimant Address Foreign Country Indicator

766

1

A/N

If the claimant’s address is in a foreign country, enter a numeric ‘1.’

Claimant Address Foreign Country Name

767-791

25

A/N

If the “Claimant Address Foreign Country Indicator” is a ‘1,’ enter the name of the foreign country.

Attorney Last Name

792-821

30

A/N

The last name of the claimant’s attorney or firm name.

Attorney First Name

822-841

20

A/N

The first name of the claimant’s attorney.

Attorney Phone Number

842-851

10

A/N

The phone number of the claimant’s attorney.

Attorney Phone Extension Number

852-857

6


A/N

The phone number extension of the claimant’s attorney.

Attorney Address Line 1

858-897

40

A/N

The street address of the claimant’s attorney.

Attorney Address Line 2

898-937

40

A/N

The address information of the claimant’s attorney.

Attorney Address City Name

938-967

30

A/N

The city of the claimant’s attorney.

Attorney Address State Code

968-969

2

A/N

The state alphabetic code of the claimant’s attorney.

Attorney Address Zip Code

970-984

15

A/N

The ZIP Code of the claimant’s attorney. U.S. ZIP Codes must be 5 or 9 characters. Foreign ZIP Codes may be up to 15 characters.

Attorney Address Foreign Country Indicator

985

1

A/N

If the attorney’s address is in a foreign country, enter a numeric ‘1.’

Attorney Address Foreign Country Name

986-1010

25

A/N

If the “Attorney Address Foreign Country Indicator” is a “1,” enter the name of the foreign country.

Third Party Administrator Company Name

1011-1050

40

A/N

The name of the TPA’s company.

Third Party Administrator Contact Last Name

1051-1080

30

A/N

The TPA contact’s last name.

Third Party Administrator Contact First Name

1081-1100

20

A/N

The TPA contact’s first name.

Third Party Administrator Company Phone Number

1101-1110

10


A/N

The TPA contact’s phone number.

Third Party Administrator Company Phone Extension Number

1111-1116

6

A/N

The TPA contact’s phone extension number.

Third Party Administrator Address Line 1

1117-1156

40

A/N

The TPA’s street address.

Third Party Administrator Address Line 2

1157-1196

40

A/N

The TPA’s address information.

Third Party Administrator Address City Name

1197-1226

30

A/N

The TPA’s city.

Third Party Administrator Address State Code

1227-1228

2

A/N

The state alphabetic code for the TPA.

Third Party Administrator Zip Code

1229-1243

15

A/N

The ZIP Code for the TPA’s address. U.S. ZIP Codes must be 5 or 9 characters. Foreign ZIP Codes may be up to 15 characters.

Third Party Administrator Address Foreign Country Indicator

1244

1

A/N

If the TPA’s address is in a foreign country, enter a numeric ‘1.’

Third Party Administrator Address Foreign Country Name

1245-1269

25

A/N

If the “Third Party Administrator Address Foreign Country Indicator” is a ‘1,’ enter the name of the foreign country.

Employer Name

1270-1309

40

A/N

The claimant’s employer.

Employer Phone Number

1310-1319

10


A/N

The employer’s phone number.

Employer Phone Extension Number

1320-1325

6

A/N

The phone extension number for the claimant’s employer.

Employer Address Line 1

1326-1365

40

A/N

The employer’s street address.

Employer Address Line 2

1366-1405

40

A/N

The employer’s address information.

Employer Address City Name

1406-1435

30

A/N

The employer’s city.

Employer Address State Code

1436-1437

2

A/N

The state alphabetic code for the employer.

Employer Address Zip Code

1438-1452

15

A/N

The ZIP Code for the employer’s address. U.S. ZIP Codes must be 5 or 9 characters. Foreign ZIP Codes may be up to 15 characters.

Employer Address Foreign Country Indicator

1453

1

A/N

Enter a numeric ‘1’ if the Employer’s address is in a foreign country.

Employer Address Foreign Country Name

1454-1478

25

A/N

Enter the name of the foreign country if the “Employer Address Foreign Country Indicator” is a ‘1.’

Filler

1479-1487

9

A/N

Reserved for future use, fill with spaces.

Claim Adjuster Name

1488-1517

30

A/N

The name of the insurer’s claim adjuster.

Claim Adjuster Phone

1518-1527

10

A/N

The claim adjuster’s phone number.

NAIC Code

1528-1532

5

A/N

The insurer’s National Association of Insurance Commissioners code.

Filler

1533-1600

68

A/N

Reserved for future use, fill with spaces.


THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13): Public reporting burden for this collection of information is estimated to average 5 minutes per electronic response and 6 minutes per manualy response for processing input and output files, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.




File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleIM Implementation Guide
AuthorOCSE Company
File Modified0000-00-00
File Created2021-01-21

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