Last Updated: August 12, 2021
The data layout for the submission of medical malpractice insurance certificates follows.
Header Record
| Field Name | Starting
Position | Length | Description |
|---|
| record type | 1 | 1 (Note: the value here will always be 1.) | This field differentiates the header record (type 1 insurance company information) from the detail record (type 2 insured specific information) |
| carrier name | 2 | 45 | Name of insurer |
| addr_text1 | 47 | 30 | First line of insurer street address |
| addr_text | 77 | 30 | Second line of insurer street address |
| city_text | 107 | 28 | Insurer city |
| state_code | 135 | 2 | Insurer state
|
| postal_code | 137 | 10 | Insurer Zip code |
| naic_company_code | 147 | 8 | Insurer NAIC code |
| irs_id_number | 155 | 9 | Insurer tax indentification number |
| company_type_ind | 164 | 1 | Licensed/authorized insurer use "1." Self insurer use "2." |
| run_date | 165 | 8 | Provide date filed created |
Detail Record
| Field Name | Starting
Position | Length | Description |
|---|
| record type | 1 | 1 (Note: the value here will always be 2.) | This field differentiates the header record (type 1 insurance company information) from the detail record (type 2 insured specific information) |
| policy_id_number | 2 | 22 | Insured policy number |
| policy_form_nbr | 24 | 25 | OCI approved medical maplractice policy form number |
| eff_ins_date | 49 | 8 | Effective date of coverage |
| expir_ins_date | 57 | 8 | Expiration date of coverage |
| rev_eff_date | 65 | 8 | For revision provide effective date of change. For new/renew or termination leave blank. |
| canc_ins_date | 73 | 8 | For termination provide effective date of termination. For new/renew or revision leave blank. |
| retoa_ins_date | 81 | 8 | For clains-made policies provide retroactive date |
| malp_cov_code | 89 | 1 | For claims-made policies use "1." For occurrence policies use "2." |
| policy_occur_lim | 90 | 9 | Per occurence limit |
| policy_aggr_lim | 99 | 9 | Annual aggregate limit |
| prvd_license_nbr | 108 | 7 | For people provide license number (MD, OD, or RN) |
| name_data | 115 | 45 | For entities provide full name. For people leave blank |
| last_name | 160 | 25 | Person last name. For entities leave blank |
| 1st_name | 185 | 15 | Person first name. For entities leave blank |
| midl_name | 200 | 15 | Person middle name. For entities leave blank |
| name_sufx | 215 | 3 | For example: Sr. Jr., III |
| addr_text1 | 218 | 30 | Insured address line 1 |
| addr_text2 | 248 | 30 | Insured address line 2
|
| city_text | 278 | 28 | Insured city |
| state_text | 306 | 2 | Insured state |
| postal_code | 308 | 10 | Insured Zip code |
| irs_id_number | 318 | 9 | For entities provide tax id. For people leave blank. |
| iso_class_code | 327 | 5 | ISO code |
| prvd_type_ind | 332 | 2 | Fund provider type - see
Fees page for current fee grid. |
| coverage_limit_ind | 334 | 1 (Note: This column can be one of the following: "Y", "N" or blank.) | Leave blank. This indicator is not currently used. |
| processing_type | 335 | 1 (Note: This value can only be one of the following: 1 = new certificate, 2 = revise certificate, 3 = terminate certificate. Revised date, ISO code, provider type are required for revising a certificate. Termination date is required for terminating a certificate.) | See description in column C. |