Texas Administrative Code
Title 28 - INSURANCE
Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION
Chapter 124 - INSURANCE CARRIERS: NOTICES, PAYMENTS, AND REPORTING
Subchapter B - INSURANCE CARRIER CLAIM ELECTRONIC DATA INTERCHANGE REPORTING TO THE DIVISION
Section 124.102 - Definitions
Current through Reg. 49, No. 38; September 20, 2024
The following words and terms when used in this subchapter will have the following meanings, unless the context clearly indicates otherwise:
(1) Application acknowledgment code--A code used to identify the accepted or rejected status of the transaction being acknowledged.
(2) Claim EDI record--The accurate data associated with a single claim reported in a claim EDI transaction (first report of injury or subsequent report of injury) obtained from all sources, including the report of incident or injury and the insurance carrier's claim file.
(3) Claim EDI transmission--The data that is contained within the interchange envelope.
(4) Division--The Texas Department of Insurance, Division of Workers' Compensation or its data collection agent.
(5) EDI--Electronic data interchange.
(6) Edit Matrix--A table containing the edits applied to Texas' first report of injury and subsequent report of injury records.
(7) Element requirement table--A table containing data elements used in Texas' first report of injury and subsequent report of injury record layouts defining required and conditional data elements and how data edits apply to the elements.
(8) Event table--A table containing the reportable claim events for Texas' first report of injury and subsequent report of injury records and timeframes for reporting the information.
(9) Insurance carrier claim number--An identifier that distinguishes a specific claim within an insurance carrier's claim processing system and is used throughout the life of the claim.
(10) IAIABC--The International Association of Industrial Accident Boards and Commissions.
(11) Person--A person, partnership, corporation, hospital district, insurance carrier, organization, business trust, estate trust, association, limited liability company, limited liability partnership, or other entity. This term does not include an injured employee.
(12) Trading partner--A person entering into an agreement with the insurance carrier to format electronic data for transmission to the division, transmit electronic data to the division, and respond to any technical issues related to the contents or structure of an EDI file.
