Claim record - Type 1 - Worker and all claim details Fixed record length of 1412 characters including CR/LF record delimiter: Position Values EDI DOC TYP TCDE char(3) 0001 - 0003 7.2 Table 2 EDI REC TYPE IND char(1) 0004 - 0004 7.6 6 SI CLAIM NO char(20) 0005 - 0024 EMP NO decimal(8.0) 0025 - 0032 EMP LOCN NO decimal(4.0) 0033 - 0036 DTE decimal(8.0) 0037 - 0044 DECEASED DTE decimal(8.0) 0045 - 0052 0053 - 0056 LANGUAGE TCDE char(4) Appendix C 0057 - 0057 GENDER IND char(1) 7.4 Table 4 Worker 0058 - 0082 WORKER GIVEN NME char(25) 0083 - 0107 WORKER MIDDLE NME Char (25) details 0108 - 0132 WORKER SUR NME char(25) 0133 - 0157 WORKER PRIOR SUR NME 1 char(25) 0158 - 0182 WORKER PRIOR SUR NME 2 char(25) 0183 - 0207 WORKER PRIOR SUR NME 3 char(25) 0208 - 0211 WORKER POSTCODE decimal(4.0) 0212 - 0219 INJ DTE decimal(8.0) Claim 0220 - 0227 CC NOTICE FROM WORKER DTE decimal(8.0) Summary 0228 - 0228 DETERM STATUS FLG char(1) 7.1 Table 1 details 0229 - 0236 DETERM STATUS CHG DTE decimal(8.0) 0237 - 0244 CLAIM CLOSED DTE decimal(8.0) DECEASED CAUSE FLG char(1) 0245 - 0245 DUTY STATUS IND char(1) 0246 - 0246 7.7 Table 7
Claim record - Type 1 - Worker and all claim details Fixed record length of 1412 characters including CR/LF record delimiter: Position Values EDI DOC TYP TCDE char(3) 0001 - 0003 7.2 Table 2 EDI REC TYPE IND char(1) 0004 - 0004 7.6 6 SI CLAIM NO char(20) 0005 - 0024 EMP NO decimal(8.0) 0025 - 0032 EMP LOCN NO decimal(4.0) 0033 - 0036 Worker details DTE decimal(8.0) 0037 - 0044 DECEASED DTE decimal(8.0) 0045 - 0052 LANGUAGE TCDE char(4) 0053 - 0056 Appendix C GENDER IND char(1) 0057 - 0057 7.4 Table 4 WORKER GIVEN NME char(25) 0058 - 0082 WORKER MIDDLE NME Char (25) 0083 - 0107 WORKER SUR NME char(25) 0108 - 0132 WORKER PRIOR SUR NME 1 char(25) 0133 - 0157 WORKER PRIOR SUR NME 2 char(25) 0158 - 0182 WORKER PRIOR SUR NME 3 char(25) 0183 - 0207 WORKER POSTCODE decimal(4.0) 0208 - 0211 Claim Summary details INJ DTE decimal(8.0) 0212 - 0219 CC NOTICE FROM WORKER DTE decimal(8.0) 0220 - 0227 DETERM STATUS FLG char(1) 0228 - 0228 7.1 Table 1 DETERM STATUS CHG DTE decimal(8.0) 0229 - 0236 CLAIM CLOSED DTE decimal(8.0) 0237 - 0244 DECEASED CAUSE FLG char(1) 0245 - 0245 DUTY STATUS IND char(1) 0246 - 0246 7.7 Table 7
Self-Insurer-EDI-Technical-Specification-V14.docx