name and address reporting for poc - national … in‐state address ... populate the name and...

NCCI’s 2018 Data Educational ProgramJanuary 30–February 2, 2018

Palm Beach County Convention CenterWest Palm Beach, FL

The Path to Data Excellence

Name and Address Reporting for POC

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© Copyright 2018 National Council on Compensation Insurance, Inc. All Rights Reserved.

Name and AddressReporting for POC

Presented by:Amy Royce and Jorge Acevedo


NCCI’s 2018 Data Educational Program

Objective

To provide a clear understanding of how the correct linking of Name and Address records will increase your Proof of Coverage (POC) success rate.

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2



Agenda

Concept of Linking and Linking Data Elements

Name and Address Linking Examples

Broken Links

3



NameAddressEmployer

What Is an Employer?

4

3



Address

What Is an Employer?

5

Name



Concept of Linking

6

A&J Cafe

4



Linking Name and Address

7

Name Link Counter Identifier

Name Link Identifier



Concept of Linking

8



5



Name Link Reporting

9





Name Link Identifier Review

Located on Name and Address Records

Primary Insured is always 001

For each additional employer, increase the Name Link Identifier by 1 (e.g., 002)

Name Link Identifier must be the same for the name and address to be linked

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6



Name Link Counter Identifier Review

Located on Name and Address Records

Accommodates policies with more than 999 unique employers

If there are more than 999 names on the policy, report 00 in this field for the first 999 names

Increase this field by 1 for the next 999 names

If 999 or fewer names are being reported, this field should be reported as 00

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Concept of Linking

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A&J Cafe

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Name Nm Lnk ID Cont Seq Nbr

Jorge Phillie 001 001

Amy Noles 001 002

dba FanTastic Sports 001 003

1. Continuation of an entity name2. All operating in the same locations

Continuation Sequence Number

Continuation of a Name

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Continuation Sequence Number Review

Located on the Name Record only

Primary Insured Name is always 001

Identifies each name of an employer with multiple names

Only report 002 or greater when the employer has multiple names

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8



Concept of Linking

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A&J Cafe



State Code Link

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A&J Treats Inc

A&J Cafe

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Address Types & State Code Link Review

Address Type 1

The mailing address (Primary Insured)

State Code Link does not apply but can be reported

Address Type 2

Physical locations of operations

State Code Link does not apply unless reporting an out of state address

Address Type 6

No specific location in jurisdiction

State Code Link Required on every Address Type 6 record

All three address types are considered employer addresses.

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Reporting Address Type 2

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The Roofing Co.1 Main St, Kingsport, TN

SCL 41

SCL 16

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Address Type NLI SCL

1 Main St Kingsport TN 1 001 41






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6 001 45

* No physical location in VA but performs work there

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State Code Link Review

Located on Address Record only Not required for Address Type 1 Not required for Address Type 2 when reporting a physical in‐state address

Required for Address Type 2 when reporting a physical out‐of‐state address

Required for Address Type 6 when reporting a No Physical Location

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Quiz Time!

Which Data Element should be unique for each distinct entity?

Which Data Element links the Employer to the State?

Which Data Element was created to support policies with more than 1,000 names?

Which Data Element is used to differentiate different names of a multi‐name entity?

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12


Name and Address Linking Examples



One Name—One Address

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A & J Cafe

1 Main St, Boca Raton, FL 33487

Name

A & J Cafe

Address

1 Main St Boca Raton FL 33487

NLI CSN

001 001

NLI SLC

001 09

NLCI

00

NLCI

00

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Multiple Names—One Address

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Jorge Acevedo—001 001—1 Main St



Continuation Sequence Number Review

When should you use the same Name Link Identifier with different Continuation Sequence Numbers?

1. Continuation of a Name

2. Operating at All the Same Location(s)

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14



Continuation of a Name

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Jorge Acevedo and Amy Royce dba A&J Cafe

Name NLI CSN

Jorge Acevedo 001 001

Amy Royce 001 002

dba A&J Cafe 001 003

Address NLI SCL

1 Main St Boca Raton FL 001 09




Employers Created

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Name Address

Jorge Acevedo 1 Main St Boca Raton FL

Amy Royce 1 Main St Boca Raton FL

dba A&J Cafe 1 Main St Boca Raton FL

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Name Standardization Changes

For Policies Effective 01/01/2017 and later:

NCCI will no longer split names

For Policies Effective 12/31/2016 and earlier:

NCCI will continue to split names as it currently does

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Name Standardization Changes

Jorge Acevedo and Amy Royce dba A&J Cafe

Employers Created

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Name Address

Jorge Acevedo & Amy Royce dba A&J Cafe

1 Main St Boca Raton FL

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Not Operating at Same Locations

John Smith and Jane Jones dba Boca Boats


John Smith and Jane Jones dba Miami Boats

8 North St, Miami, FL 33313

Note: Both employers have the same FEIN.

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NCCI’s 2018 Data Educational Program32

Name NLI CSN

John Smith 001 001

Jane Jones 001 002

dba Boca Boats 001 003

dba Miami Boats 001 004


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Employers Created

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Name Address

John Smith 6 Main St Boca Raton FL

Jane Jones 6 Main St Boca Raton FL

Boca Boats dba 6 Main St Boca Raton FL

Miami Boats dba 6 Main St Boca Raton FL

John Smith 8 North St Miami FL

Jane Jones 8 North St Miami FL

Boca Boats dba 8 North St Miami FL

Miami Boats dba 8 North St Miami FL




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Name NLI CSN

John Smith 001 001

Jane Jones 001 002

dba Boca Boats 001 003

John Smith 002 001

Jane Jones 002 002

dba Miami Boats 002 003

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35

Address NLI SCL

6 Main St Boca Raton FL 001 09

8 North St Miami FL 002 09



Employer Records Created

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Name Address

Boca Boats dba 6 Main St Boca Raton FL

John Smith 6 Main St Boca Raton FL

Jane Jones 6 Main St Boca Raton FL

Miami Boats dba 8 North St Miami FL

John Smith 8 North St Miami FL

Jane Jones 8 North St Miami FL

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Name and Address Linking

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FL Beef Inc—001 001—Type 1



One Name—Multiple Locations

FL Beef Inc

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• 1 Main St, Boca Raton, FL

• 6 West St, Denver, CO

• Operating in Georgia (no physical location)

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One Name—Multiple Locations

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Name NLI CSN

FL Beef Inc 001 001


1 Main St Boca Raton FL 1 001 09

6 West St Denver CO 2 001 05

6 001 10




Name Street City State

FL Beef Inc 1 Main St Boca Raton FL

FL Beef Inc 6 West St Denver CO

FL Beef Inc GA

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Name and Address Linking Exercise 1



SCL 09

Linking Exercise #1

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SCL 43

SCL 10

Mama Mia

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Linking Exercise #1—How Is This?

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Name NLI CSN

Mama Mia Pizzeria 001 100


1 Pepperoni St Palm Beach FL 1 001 09

6 Sausage St Orem UT 2 002 09

Various Locations 2 003 10

The policy has a named insured, Mama Mia Pizzeria with a Mailing address in Florida (SCL 09). The insured is also operating in Georgia (SCL 10) delivering pizzas, but does not have a physical location in the state. And there is also a second location in Utah (SCL 43). Circle all errors on the following records:



Linking Exercise #1—Answer

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Name NLI CSN


Populate the Name and Address fields with the correct data:

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45

Jorge Inc—001 001—1 Main St




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Name NLI CSN

Jorge Inc 001 001

Amy Inc 001 002

dba J Shoes 001 003


1 Main St Boca Raton FL 1 001 09

5 South St Miami FL 2 001 09

9 North St Orlando FL 2 001 09

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Name Street City State

Jorge Inc 1 Main St Boca Raton FL

Jorge Inc 5 South St Miami FL

Jorge Inc 9 North St Orlando FL

Amy Inc 1 Main St Boca Raton FL

Amy Inc 5 South St Miami FL

Amy Inc 9 North St Orlando FL

J Shoes dba 1 Main St Boca Raton FL

J Shoes dba 5 South St Miami FL

J Shoes dba 9 North St Orlando FL

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Name and Address Linking Exercise 2

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Linking Exercise #2

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Jorge Antipasto, Inc dba TGI Jorges

1 Anchovy St, Boca Raton, FL

(Mailing Address)

6 Linguine St, Newport, RI

Amy Ravioli, Inc 1 Anchovy St, Boca Raton, FL Operating in New York with no physical location

in the state

Note: Jorge Antipasto, Inc is the Primary Insured



Linking Exercise #2

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Name NLI CSN

Address AddressType

NLI SCL

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Linking Exercise #2

How many Employer Records will be created per State?

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State # of Employers


Broken Links

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Data Grade 7

Unlinked Names records will generate a Data Grade 7 error

Unlinked Address records will generate a Data Grade 7 error

These records will NOT be sent to the state

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Name Effective Date

One date for each unique name on the policy

Set when name is first reported on the policy

Cannot be changed Can be reset by deleting all occurrences of the name from the policy

Depending upon how you reported the names and addresses, this can affect several employers in several states.

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Address Effective Date

One date for each unique standardized address on the policy

Set when address is first reported on the policy Cannot be changed Can be reset by deleting all occurrences of the address from the policy

This means:

Address Type 6 One effective date per state

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Pitfalls of Broken Links

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NLI CSN Name Address

001 001 Jorge Inc 2 Main St

002 001 Amy Inc 5 South St

003 001 Jeff Inc 11 North St

004 001 Bob Inc 17 East St

005 001 Jane Inc 23 West St

006 001 Greg Inc 31 First Ave

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NLI CSN Name Address

001 001 Jorge Inc 2 Main St

001 002 Amy Inc 5 South St

001 003 Jeff Inc 11 North St

001 004 Bob Inc 17 East St

001 005 Jane Inc 23 West St

001 006 Greg Inc 31 First Ave

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Jorge Inc—2 Main St

Jorge Inc—2 Main St

Bob Inc—17 East St

Jane Inc—23 West St

Greg Inc—31 First AveJeff Inc—11 North St

Amy Inc—5 South St

Jorge Inc—5 South St

Amy Inc—11 North St

Jeff Inc—17 East St

Bob Inc—23 West St

Jane Inc—31 First Ave

Greg Inc—2 Main St

Jorge Inc—11 North StJorge Inc—17 East St

Jorge Inc—23 West St

Amy Inc—17 East St

Amy Inc—31 First Ave

Bob Inc—2 Main St

Amy Inc—2 Main St

Jeff Inc—2 Main StJeff Inc—5 South St

Jane Inc—5 South St

Jane Inc—11 North St

Greg Inc—5 South St

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Another Pitfall

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Changing NLI from one transaction to another can lead to unexpected results.

Best Practice:

Report the same NLI throughout the life of the policy for each employer.



Changing NLI Pitfall

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NLI CSN Name PCED PCXD

001 001 First Employer 000000 000000

002 001 Second Employer 000000 000000

003 001 Third Employer 000000 000000

NLI Type Street City ST SCL PCED PCXD

001 1 5 East St Boca Raton FL 09 000000 000000

001 6 39 000000 000000

002 6 39 000000 000000

003 6 39 000000 000000

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Policy Effective: 01/01/18

Changes to be reported:

Second Employer is being deleted midterm (effective 04/01/18)

A new employer is being added midterm (effective 07/01/18)

Operating in South Carolina (no physical location)

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001 001 First Employer 000000 000000

002 001 Second Employer 180401 180401

003 001 Third Employer 000000 000000

004 001 Fourth Employer 180701 000000



001 6 39 000000 000000

002 6 39 180401 180401

003 6 39 000000 000000

004 6 39 180701 000000

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001 001 First Employer 000000 000000

004 001 Second Employer 180401 180401

002 001 Third Employer 000000 000000

003 001 Fourth Employer 180701 000000



001 6 39 000000 000000

004 6 39 180401 180401

002 6 39 000000 000000

003 6 39 180701 000000




Reminder:

What were we trying to do?

Delete Second Employer, Effective 04/01/18

Add Fourth Employer, Effective 07/01/18

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Flag NLI CSN Name NED NXD PCED PCXD

N 001 001 First Employer 01/01/18

N 002 001 Third Employer 01/01/18

N 003 001 Fourth Employer 07/01/18 07/01/18

Y 001 001 First Employer 01/01/18

Y 002 001 Second Employer 01/01/18 04/01/18 04/01/18

Y 003 001 Third Employer 01/01/18

Flag NLI CSN Name NED NXD PCED PCXD

N 001 001 First Employer 01/01/18

N 002 001 Second Employer 01/01/18

N 003 001 Third Employer 01/01/18

What NCCI Loads …

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NLI CSN Name PCXD

004 001 Second Employer 04/01/18



Flag NLI SCL Address AED AXD PCED PCXD

N 001 09 5 East St 01/01/18

N 001 39 01/01/18

N 002 39 01/01/18

N 003 39 07/01/18 07/01/18

Y 001 09 5 East St 01/01/18

Y 001 39 01/01/18 04/01/18 04/01/18

Y 002 39 01/01/18

Y 003 39 01/01/18

Flag NLI SCL Address AED AXD PCED PCXD

N 001 09 5 East St 01/01/18

N 001 39 01/01/18

N 002 39 01/01/18

N 003 39 01/01/18

What NCCI Loads …

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NLI SCL Address PCXD

004 39 04/01/18

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What the POC Process Generates …

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Rec Type Name Address Triplicate

Trans Set Eff Dt

PC1 First Employer 5 East St 00/33/87 04/01/18

PC2 Second Employer DELETE


PC2 First Employer DELETE


PC2 First Employer ADD


PC2 Fourth Employer ADD



Questions?

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Supplemental Information

Presenter Biographies

Amy Royce, AU, AINS, joined NCCI 22 years ago and is currently a consultant in the Data Services Department of Data Resources. Her primary responsibilities include Proof of Coverage management and industry communication. She also represents NCCI on the International Association of Industrial Boards and Commissions as the POC Committee Chair.

Amy earned a bachelor’s in human resource management from Palm Beach Atlantic University in Florida as well as Associate of Commercial Underwriting (AU) and Associate in General Insurance (AINS) designations and is currently working on completing her Insurance Data Management Association (IDMA) certification.

Jorge Acevedo has been with NCCI since 2005. He is the Proof of Coverage lead data analyst on the Policy/Proof of Coverage Team in the Data Collection Department. Prior to joining Data Collection in 2007, he worked in the Experience Rating Department as an analyst.

Jorge’s professional background includes technical support for a major computer company and fraud detection for an Internet hosting company.

© Copyright 2018 National Council on Compensation Insurance, Inc. All Rights Reserved

POLICY & POC ACRONYM REFERENCE SHEET Data Elements Reported on WCPOLS—Carrier‐Generated NLI—Name Link Identifier NLCI—Name Link Counter Identifier CSN—Continuation Sequence Number SCL—State Code Link PED—Policy Effective Date PXD—Policy Expiration Date PCED—Policy Change Effective Date PCXD—Policy Change Expiration Date

Data Elements NOT Reported in WCPOLS—NCCI‐Generated NED—Name Effective Date AED—Address Effective Date NXD—Name Expiration Date AXD—Address Expiration Date SNN—Split‐Name Number

Codes Reported in Acknowledgment—POC & State Generated PC1—IAIABC POC Insured Record PC2—IAIABC POC Employer Record TA—Transaction Accepted TE—Transaction Accepted With Errors TR—Transaction Rejected

TransactionSubmission

Code

Transaction

Triplicate

POC

1.0

POC

2.1

POC

3.0

Assigned Risk Binder I 00‐04‐80 XPOC 1.0 ‐ Binder

POC 2.1 ‐ Coverage Notice/Binder ‐ some/all Employer locations within Jurisdiction

POC 3.0 ‐ POC Notice ‐ some or all employer locations within Jurisdiction

A 00‐05‐01 X X X

POC 1.0 ‐ Binder ‐ Insured has no physical location in jurisdiction

POC 2.1 ‐ Coverage Notice/Binder ‐ Insured has no Physical location within Jurisdiction

POC 3.0 ‐ POC Notice ‐ without location(s) within Jurisdiction

I 00‐05‐80 X X X

POC 1.0 ‐ Binder ‐ Named Employer(s) with no jurisdiction address

POC 2.1 ‐ Coverage Notice/Binder ‐ Employers with No Physical Address, but Operating within the

Jurisdiction

POC 3.0 ‐ POC Notice ‐ with no physical locations within jurisdiction but operating within the

Jurisdiction

EN/M 00‐05‐86 X X X

POC 1.0 ‐ New Policy

POC 2.1 ‐ New Policy ‐ all/some employer locations with locations

POC 3.0 ‐ New Policy ‐ some or all employer locations within Jurisdiction

A 00‐10‐01 X X X

POC 1.0 ‐ New Policy ‐ Insured has not physical location in jurisdiction

POC 2.1 ‐ New Policy ‐ Insured has no Physical Location within Jurisdiction

POC 3.0 ‐ New Policy ‐ Without location(s) within Jurisdiction

I 00‐10‐80 X X X

POC 1.0 ‐ New Policy ‐ Named Employer(s) with no jurisdiction address

POC 2.1 ‐ New Policy ‐ Employers with No Physical Address, but Operating within the Jurisdiction

POC 3.0 ‐ New Policy ‐ with no physical locations within the Jurisdiction but operating within the

Jurisdiction

EN/M 00‐10‐86 X X X

POC 1.0 ‐ Renew Policy

POC 2.1 ‐ Renewal ‐ all/some employer locations within Jurisdiction

POC 3.0 ‐ Renewal ‐ some or all employer locations within Jurisdiction

A 00‐20‐01 X X X

POC 1.0 ‐ Renew Policy ‐ Insured has no physical location in jurisdiction

POC 2.1 ‐ Renewal ‐ Insured has no Physical location with Jurisdiction

POC 3.0 ‐ Renewal ‐ without location(s) within Jurisdiction

I 00‐20‐80 X X X

POC 1.0 ‐ Renew Policy ‐ Named Employer(s) with no jurisdiction address

POC 2.1 ‐ Renewal Policy ‐ Employers with No Physical Address, but Operating within the Jurisdiction

POC 3.0 ‐ Renewal Policy ‐ with no physical locations within the Jurisdiction but operating within the

Jurisdiction

EN/M 00‐20‐86 X X X

POC 1.0 ‐ Add Jurisdiction

POC 2.1 ‐ Endorsement ‐ Notifying a New Jurisdiction when a New Location is added to Existing Policy

POC 3.0 ‐ Endorsement ‐ notifying a new Jurisdiction when a location is added to existing policy

A 00‐31‐72 X X X

POC 1.0 ‐ Add Jurisdiction with no State location

POC 2.1 ‐ Endorsement ‐ Notifying a New Jurisdiction when a New Employer with No jurisdiction

location is added to Existing Policy

POC 3.0 ‐ Endorsement ‐ notifying a new Jurisdiction when an employer with no Jurisdiction location is

added to existing policy

I 00‐31‐80 X X X

POC 1.0 ‐ Add Jurisdiction ‐ Named Employer(s) with no jurisdiction address

POC 2.1 ‐ Add New Employer ‐ Add (Employer Not in Jurisdiction)

POC 3.0 ‐ Endorsement ‐ notifying a new Jurisdiction when an employer with no physical location but

operating within the Jurisdiction is added to existing policy

EN/M 00‐31‐86 X X X

POC 1.0 ‐ Rewrite/Reissue Policy

POC 2.1 ‐ Rewrite/Reissue Policy ‐ Employer Locations within Jurisdiction

POC 3.0 ‐ Rewrite/Reissue Policy ‐ some or all employer locations within Jurisdiction

A 00‐50‐01 X X X

POC 1.0 ‐ Rewrite/Reissue Policy ‐ Insured has no physical location in Jurisdiction

POC 2.1 ‐ Rewrite/Reissue Policy ‐ Insured has No Physical Location within Jurisdiction

POC 3.0 ‐ Rewrite/Reissue Policy ‐ without location(s) within Jurisdiction

I 00‐50‐80 X X X

IAIABC Triplicate History by POC Format

Notification of Coverage

1


Code

Transaction

Triplicate

POC

1.0

POC

2.1

POC

3.0


POC 1.0 ‐ Rewrite/Reissue Policy ‐ Named Employer(s) with no jurisdiction address

POC 2.1 ‐ Rewrite/Reissue Policy ‐ Employers with No Physical Address, but Operating within the

Jurisdiction

POC 3.0 ‐ Rewrite/Reissue Policy ‐ with no physical locations within the Jurisdiction but operating

within the Jurisdiction

EN/M 00‐50‐86 X X X

POC 1.0 ‐ Add Location(s)

POC 2.1 ‐ Add New Employer ‐ Add ‐ (Location in Jurisdiction)

POC 3.0 ‐ Add Employer location within Jurisdiction

E/M 00‐31‐54 X X X

POC 1.0 ‐ Add Employer(s) with no jurisdiction address

POC 2.1 ‐ Add Employer ‐ Add (Employer not in Jurisdiction)

POC 3.0 ‐ Add New Employer with no Physical Location within Jurisdiction

E/M 00‐31‐87 X X X

POC 1.0 ‐ Include Corporate Officer/Partner/Sole Proprietor

POC 2.1 ‐ Submitting Corporate Officer/Partner/Sole Proprietor ‐ Inclusion

POC 3.0 ‐ Corporate Officer/Partner/Sole Proprietor ‐ Inclusion

I 00‐32‐67 X X X

POC 1.0 ‐ Exclude Corporate Officer/Partner/Sole Proprietor

POC 2.1 ‐ Submitting Corporate Officer/Partner/Sole Proprietor ‐ Exclusion

POC 3.0 ‐ Corporate Officer/Partner/Sole Proprietor ‐ Exclusion

I 00‐32‐68 X X X

POC 1.0 ‐ Change ‐ Change Legal Status, Change Insured Name, Change Governing Class Code, Change

Total Payroll, Change Insured Address, Change Telephone Number, Change Business Market, Change

Wrap Up Indicator, Change Assignment Date

POC 2.1 ‐ Change Insured Demographics

Legal Status, Insured Name, Governing Class, Total Payroll, Insured Address, Telephone Number,

Business Market, Wrap‐Up Indicator, Assignment Date, Employee Leasing Policy Identification,

Minimum Premium Policy Indicator

I 00‐32‐84 X X

Change Insured Demographics

Legal Status, Insured Name, Governing Class, Total Payroll, Insured Address, Telephone Number,

Business Market, Wrap‐Up Indicator, Assignment Date, Employee Leading Policy Identification,

Minimum Premium Policy Indicator, Losses Subject to Deductible Code, Basis of Deductible Calculation

Code, Insured Sate Premium, PEO or Client Company Code, Reason State was Added to the Policy Code

I04‐32‐84

05‐32‐84X

Change Prior Policy Number PI

04‐32‐75

05‐32‐75 X

Add new Insured FEIN PI04‐32‐76

05‐31‐76X

POC 1.0 ‐ Change Erroneous Insured FEIN

POC 2.1 ‐ Change Insured FEINPI

04‐33‐76

04‐32‐76X X

Change Insured FEIN PI04‐32‐76

05‐32‐76X

POC 1.0 ‐ Change Employer FEIN

POC 2.1 ‐ Change Employer FEIN ‐ Employer Locations within Jurisdiction

POC 3.0 ‐ Change Employer FEIN ‐ Employer locations within Jurisdiction

PE04‐32‐77

05‐32‐77X X X

POC 1.0 ‐ Change Employer UI

POC 2.1 ‐ Change Employer U/I ‐ Employer Locations within Jurisdiction

POC 3.0 ‐ Change Employer UI Number ‐ employer locations within Jurisdiction

PE04‐32‐78

05‐32‐78X X X

POC 1.0 ‐ Change ‐ Change Name ‐ all or any employer location, Change Address ‐ all or any Employer

location, Change SIC Code (Employer level), Change # of Employees (Employer level)

POC 2.1 ‐ Change Employer Demographics ‐ Employer Locations with Jurisdiction

Name, Address, SIC Code, Number of Employees

POC 3.0 ‐ Change Employer Demographics ‐ Employer location within Jurisdiction

Name, Address, Industry Code, Number of Employees, Legal Status of Employer, Name Type Code, PEO

or Client Company Code

PE04‐32‐85

05‐32‐85X X X

Addition of Coverage

Change of Existing of Coverage

2


Code

Transaction

Triplicate

POC

1.0

POC

2.1

POC

3.0


POC 2.1 ‐ Change Employer Demographics Employer with No Jurisdiction Location

Name, Address, SIC Code, Number of Employees

POC 3.0 ‐ Change Employer Demographics ‐ Employer with no Jurisdiction location

Name, Industry Code, Number of Employees, Legal Status of Employer, Name Type Code, PEO or Client

Company Code

PE04‐32‐94

05‐32‐94X X

POC 2.1 ‐ Change Employer U/I Number ‐ Employer with No Jurisdiction Location

POC 3.0 ‐ Change Employer UI Number ‐ employer with no Jurisdiction locationPE

04‐32‐95

05‐32‐95X X

POC 2.1 ‐ Change Employer FEIN ‐ Employer with No Jurisdiction Location

POC 3.0 ‐ Change Employer FEIN‐ employer with no physical location within Jurisdiction PE

04‐32‐96

05‐32‐96X X

Change Policy Number PI04‐32‐79

05‐32‐79X X

Change Policy Number PI04‐33‐79

05‐32‐79X

POC 1.0 ‐ Change Erroneous Effective Date

POC 2.1 ‐ Correct Erroneous Policy Effective DatePI

04‐32‐81

05‐32‐81X X

Change Policy Effective Date PI04‐33‐81

05‐32‐81X

POC 1.0 ‐ Change Erroneous Expiration Date

POC 2.1 ‐ Correct Erroneous Expiration DatePI

04‐32‐82

05‐32‐82X X

Change Policy Expiration Date PI04‐33‐82

05‐32‐82X

POC 1.0 ‐ Change Erroneous Carrier/Insurer FEIN

POC 2.1 ‐ Change Carrier/Insurer FEINPI

04‐32‐83

05‐32‐83X X

Change Carrier/Insurer FEIN PI04‐33‐83

05‐32‐83X

POC 1.0 ‐ Delete location(s)

POC 2.1 ‐ Delete Employer Locations within Jurisdiction

POC 3.0 ‐ Endorsement, Delete Location

E/M 00‐33‐56 X X X

POC 1.0 ‐ Delete Jurisdiction

POC 2.1 ‐ Delete Jurisdiction No Longer Covered by Carrier/Insurer

POC 3.0 ‐ Endorsement, Delete Jurisdiction

I 00‐33‐73 X X X

POC 2.1 ‐ Delete Employer with No Jurisdiction Location

POC 3.0 ‐ Delete Employer no Jurisdiction addressE/M 00‐33‐87 X X

Policy Cancelled By Carrier/Insurer ‐ Failure to Comply with Terms of Audit I 00‐41‐16 X

Policy Cancelled By Carrier/Insurer ‐ Cancelled at Request of Finance Company I 00‐41‐20 X

Policy Cancelled By Carrier/Insurer ‐ Failure to Submit Payroll Information I 00‐41‐23 XPOC 1.0 ‐ Cancelled By Carrier/Insurer ‐ Non Payment

POC 2.1 & POC 3.0 ‐ Policy Cancelled by Carrier/Insurer ‐ Non PaymentI 00‐41‐59 X X X

POC 1.0 ‐ Cancelled By Carrier/Insurer ‐ Underwriting Reason

POC 2.1 & POC 3.0 ‐ Policy Cancelled by Carrier/Insurer ‐ Underwriting DiscretionI 00‐41‐64 X X X

POC 1.0 ‐ Cancelled by Carrier/Insurer ‐ Revocation of Voluntary Market Acceptance

POC 2.1 & POC 3.0 ‐ Policy Cancelled by Carrier/Insurer ‐ Revocation of Voluntary Market AcceptanceI 00‐41‐66 X X X

POC 1.0 ‐ Cancelled By Carrier/Insurer ‐ Failure to Pay Deductible

POC 2.1 & POC 3.0 ‐ Policy Cancelled by Carrier/Insurer ‐ Failure to Pay DeductibleI 00‐41‐69 X X X

POC 1.0 ‐ Cancelled by Carrier/Insurer ‐ Misrepresentation of Information on Application

POC 2.1 & POC 3.0 ‐ Policy Cancelled by Carrier/Insurer ‐‐ Misrepresentation on ApplicationI 00‐41‐70 X X X

POC 1.0 ‐ Cancelled By Carrier/Insurer ‐ Rewrite/Reissue

POC 2.1 & POC 3.0 ‐ Policy Cancelled by Carrier/Insurer ‐Rewrite/ReissueI 00‐41‐71 X X X

POC 1.0 ‐ Cancelled By Insured ‐ Reason Unknown

POC 2.1 & POC 3.0 ‐ Policy Cancelled by Insured ‐ Reason UnknownI 00‐42‐01 X X X

Deletion of Coverage

Cancellation/Nonrenewal of Coverage

3


Code

Transaction

Triplicate

POC

1.0

POC

2.1

POC

3.0


POC 1.0 ‐ Cancelled By Insured ‐ Out of Business

POC 2.1 & POC 3.0 ‐ Policy Cancelled by Insured ‐ Out of BusinessI 00‐42‐45 X X X

POC 1.0 ‐ Cancelled by Insured ‐ Coverage Placed Elsewhere

POC 2.1 & POC 3.0 ‐ Policy Cancelled by Insured ‐ Coverage Placed ElsewhereI 00‐42‐60 X X X

POC 1.0 ‐ Cancelled By Insured ‐ Duplicate Coverage

POC 2.1 & POC 3.0 ‐ Policy Cancelled by Insured ‐ Duplicate CoverageI 00‐42‐61 X X X

POC 1.0 ‐ Cancelled by Insured ‐ Change of Ownership

POC 2.1 & POC 3.0 ‐ Policy Cancelled by Insured ‐ Ownership ChangeI 00‐42‐62 X X X

POC 1.0 ‐ Cancelled By Insured ‐ Business Sold

POC 2.1 ‐ Policy Cancelled by Insured ‐ Business SoldI 00‐42‐63 X X

POC 1.0 ‐ Cancelled by Insured ‐ No Employees/No Exposure/No Operations

POC 2.1 & POC 3.0 ‐ Policy Cancelled By Insured ‐ No Employees/No Exposure/No OperationsI 00‐42‐65 X X X

POC 1.0 ‐ Non‐Renewal of Policy By Insured ‐ Reason Unknown

POC 2.1 & POC 3.0 ‐ Policy Non Renewed by Insured ‐ Reason UnknownI 00‐60‐01 X X X

POC 1.0 ‐ Non‐Renewal of Policy By Insured ‐ Out of Business

POC 2.1 & POC 3.0 ‐ Policy Non Renewed by Insured ‐ Out of BusinessI 00‐60‐45 X X X

Policy Non Renewed by Carrier/Insurer ‐ Non Payment I 00‐60‐59 X X

POC 1.0 ‐ Non‐Renewal of Policy by Insured ‐ Coverage Placed Elsewhere

POC 2.1 & POC 3.0 ‐ Policy Non Renewed by Insured ‐ Coverage Placed ElsewhereI 00‐60‐60 X X X

POC 1.0 ‐ Non‐Renewal of Policy by Insured ‐ Change of Ownership

POC 2.1 & POC 3.0 ‐ Policy Non Renewed by Insured ‐ Change of OwnershipI 00‐60‐62 X X X

POC 1.0 ‐ Non‐Renewal of Policy By Insured ‐ Business Sold

POC 2.1 ‐ Policy Non Renewed by Insured ‐ Business SoldI 00‐60‐63 X X

POC 1.0 ‐ Non‐Renewal of Policy by Insurer ‐ Underwriting Discretion

POC 2.1 & POC 3.0 ‐ Policy Non Renewed by Carrier/Insurer ‐ Underwriting DiscretionI 00‐60‐64 X X X

POC 1.0 ‐ Non‐Renewal of Policy by Insured ‐ No Employees/No Exposure/No Operations

POC 2.1 & POC 3.0 ‐ Policy Non Renewed by Insured ‐ No Employees/No Exposure/No OperationsI 00‐60‐65 X X X

POC 1.0 ‐ Reinstate Policy

POC 2.1 ‐ Carrier/Insurer Reinstate PolicyI 00‐70‐01 X X X

©Copyright 2016 National Council on Compensation Insurance, Inc. All Rights Reserved

Reinstatement of Coverage

4

name and address reporting for poc - national … in‐state address ... populate the name and...

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