Plastic Card Claims Automation Specifications Document

Transcription

1 Plastic Card Claims Automation Specifications Document Version: 1.3 Last modified: April 28, 2009 The Plastic Card Policy is underwritten by CUMIS Insurance Society, Inc., a member of the CUNA Mutual Group. CUNA Mutual Group, 2008 All Rights Reserved. Any further reproduction, adoption or distribution is prohibited without CUNA Mutual s written consent

2 Card Processor Claims Automation Project Description This project will automate the plastic card claims data collection process by transmitting fraud close-out package details from a card processor to CUNA Mutual Group. The goal will be for CUNA Mutual to receive transmission files containing the required claims data from card processors and process all the received transactions automatically in APEX (CUNA Mutual's claims system) thus automating the data gathering and adjudication process of Plastic Card losses. Automating data collection and adjudication process will expedite the claims process, reduce operational costs and provide a more consistent a higher quality service to credit unions. Credit unions will no longer be required to submit any Plastic Card Claims for data sent via the automated process. By automating the claims process, CUNA Mutual reduces demand on the credit union and assures quality data is obtained. This process will also streamline internal operating procedures. In addition to the benefits to CUNA Mutual and Credit Unions, the processors would also experience long term reduction in costs by eliminating the need to produce and deliver large volumes of paper documents. Features and Benefits Decrease claims turn-around times Elimination of manually intensive processes, thereby Increasing internal operating efficiency. Reduce operational expenses: o No need to copy, , fax or mail fraud close out package detail o Minimize the back & forth of obtaining documentation o Streamline the Claims Process elimination of Proof of Loss requirement for Visa/MC losses Improve claims decision-making process Comprehensive dataset Automated business rule validation and update of the claims transaction record Improved ability to quickly and accurately identify and pay claims Greater market & customer focus, with improved customer interactions Potential to identify fraud trends more quickly Improve the Quality & Traceability of Data o Faster access and review of data o More cost-effective (no hard copy or manual intervention) o Improved data integrity (follows ISO standard) o Traceable o Comprehensive PCI Compliant Develop closer relationships between processors, credit unions and CUNA Mutual. Please note that the term Card Processor could refer to a traditional card processing company, a credit union processing their authorizations in-house or a credit union service organization. Please contact CUNA Mutual to determine the best solution for your institution. Chuck Cashman, Director Product Management CUNA Mutual Group 5910 Mineral Point Road Madison, WI chuck.cashman@cunamutual.com Confidential Page 2 version 1.3

3 REQUIREMENTS Card Processor Expectations 1. Card Processor will only send Loss/Unauthorized transactions. 2. Card processor will only send transactions for Automated Credit Unions that have signed a release with the card processor. 3. Card Processor is expected to send all transaction related to any loss (card) at a time. 4. CUNA Mutual strongly discourages the practice of sending few transactions related to a particular loss (card) in one file/day and few other transactions in a different file/day. CUNA Mutual will still accept the transactions, but this practice should be avoided. 5. If there are no Loss transactions for a day, the processor still needs to send a file with header and trailer only. 6. Card Processors should send the transactions only in the specified layout with the specified valid values. 7. File should be sorted by the Processor before transmitting to CUNA Mutual. The Sort Order is: a. Credit Union Identification Number b. Bin Number c. Account Number d. Last Name e. Transaction Date & Time f. Transaction Amount g. Approval Code (Authorization Code) Note: If file sorting occurs after transactions are created, there is a possibility that the record numbers will be out of sequence. This is an acceptable scenario. 8. If any transaction under a loss (Account) failed Data Validation, CUNA Mutual will reject all Transactions under that account even if some transactions Passed Data Validation. The Processor should resend all the Transactions under that account (Loss). 9. The maximum number of Transactions in a file should not exceed 15,000. If the loss transactions are more than 15,000 on a day then the Processor should send the transactions in multiple files each not exceeding 15,000 limit. 10. The Carriage Return line field should be there for each record in the Transaction file. (Header, Each Detail Record and Trailer Record). 11. File Naming Convention: The Processor should name the file as follows: ProcessorShortName.TRANS.CreationDate.CreationTime.txt a. Examples: i. ABC.TRANS txt ii. ABC.TRANS txt b. Note: The Creation time should be in military format. For example if the time is 2:30:30 pm, the creation time should be Confidential Page 3 version 1.3

4 Data Cleansing & Default Mapping by CUNA Mutual While validating the transaction file, if CUNA Mutual finds any invalid values for the following fields, CUNA Mutual will map the values to valid codes in order to accept the transaction: i) POS Entry Mode: Invalid codes will be mapped to '00' ii) CVV/CVC, CVV2/CVC2/CID, AVS, ECI, CAVV/AAV: Invalid codes will be mapped to '00' space(s) CUNA Mutual will communicate the invalid codes to the card processor via an (see File Transmission & Transaction Error Reject Scenarios #7). Examples: If the Processor Sends. Then CUNA Mutual Maps to. POS Entry Mode = CVV = Z space(s) CVV2 = A space(s) AVS = 1 space(s) ECI = X space(s) CAVV = M space(s) It is not required for the processor to resend transactions that were contained in the . However, the card processor should review their code to ensure accuracy for future transmissions. File Processing Timelines 1. Files received before 9:00 pm (CST) on week days (working days) will be processed on the same day. 2. Files received after 9:00 pm (CST) on working days will be processed on next working day. 3. Files received on non-working days will be processed on the next working day. Confidential Page 4 version 1.3

5 File and/or Transaction Errors That Will Cause a File or Record to Be Rejected File Transmission & Transaction Error Reject Scenarios Auto- Response If a received file name exactly matches any previously received file name, CUNA Mutual considers this a duplicate file and will reject the entire file. If the Trailer Record Count Total Dollar Amount Detail Records Minimum Amount Detail Records Maximum Amount of the received file is an exact match to one of the last 10 previously processed files, CUNA Mutual considers this as a duplicate file and reject the entire file. If the Sum of the Transaction Amounts of all the Detail Records received does not match with the Trailer Record Total Amount; (or) If the Total number of Detailed Records received does not match with the Trailer Record Count, CUNA Mutual considers the file as invalid and will reject the entire file. If more than 20% of the transactions within the file are duplicates, then CUNA Mutual consider the file as invalid and reject the entire file. CUNA Mutual will send an to the Processor as follows. The entire file has been rejected because of the following reason. The received file name is an exact match to a previously processed file. We assume this file is a duplicate. If this is not the case, please correct the file name and resend. The entire file has been rejected because of the following reason. The Trailer Record Count, Total Dollar Amount, Detail Records Minimum Amount and Detail Records Maximum Amount indicated in the received file is an exact match to one of the last 10 previously processed (CP1.TRANS txt) files. We assume this file is a duplicate. The entire file has been rejected because of the following reason(s). The Sum of the Transaction Amounts of all the Detail Records received doesn t match with the Trailer Record Total Amount. Please correct and resend the entire file. or The Total number of Detailed Records received doesn t match with the Trailer Record Count. Please correct and resend the entire file. More than 20% of the transactions within the file are duplicates. Please correct and resend the entire file. Confidential Page 5 version 1.3

6 File and/or Transaction Errors That Will Cause a File or Record to Be Rejected File Transmission & Transaction Error Reject Scenarios Auto- Response 5 6 If more than 20% of the transactions in a file have invalid Data or if more than 20% of the accounts contain Invalid Data transactions, CUNA Mutual will consider the file as invalid and reject the entire file. If the file is not sorted in the CUNA Mutual specified order, CUNA Mutual will consider the file as invalid and reject the entire file. The entire file has been rejected because of the following reason(s). More than 20% of the transactions in a file have Invalid Data. More than 20% of the Accounts contain Invalid Data transactions. 1) Account Number/Last Name: Field Names Fraud Type ( ) Card Brand ( ), Card Type ( ) 2) Account Number/Last Name: Field Names Card Brand ( ) Card Type ( ) The file received is not sorted in the order required by CUNA Mutual Group. The sort order should be i) Credit Union Identification Number ii) Bin Number iii) Account Number iv) Last Name v) Transaction Date & Time vi) Transaction Amount vii) Approval Code (Authorization Code) Please correct and resend the entire file. Confidential Page 6 version 1.3

7 File and/or Transaction Errors That Will Cause a File or Record to Be Rejected File Transmission & Transaction Error Reject Scenarios Auto- Response Scenario 1: Case where there are invalid transactions but no cleansed transactions 7 If any transaction under a loss (Account) failed one or more Data Validation rules, CUNA Mutual will reject all Transactions under that account even if some transactions Passed Data Validation. The Processor should resend all the Transactions under that account (Loss). The notification will list all invalid transactions. Note: Even though all transactions under that account are rejected only the invalid transactions under each account will be listed in the as follows. In addition to rejected transactions, CUNA Mutual would also send accepted transactions for which CUNA Mutual set the default values. The following transactions have failed the Data Validation rules and have not been processed by CUNA Mutual Group. Please correct and resend all the Transactions under that account. 1) Account Number/Last Name Fraud Type (value ) 2) Account Number/Last Name Card Brand ( ) Card Brand ( ), Card Type ( ) Thank you. CUNA Mutual Group. Scenario 2: Case where there are both invalid transactions and cleansed transactions The following transactions have failed the Data Validation rules and have not been processed by CUNA Mutual Group. Please correct and resend all the Transactions under that account. 1) Account Number/Last Name Fraud Type ( ) 2) Account Number/Last Name Card Brand ( ) Card Type ( ) The following transactions have failed the Data Validation rules. However, the invalid data has been set to default values in order to accept the transaction. Confidential Page 7 version 1.3

8 File and/or Transaction Errors That Will Cause a File or Record to Be Rejected File Transmission & Transaction Error Reject Scenarios Auto- Response 1) Account Number/Last Name AVS ( ) CVV2/CVC2/CID ( ), AVS ( ) 2) Account Number/Last Name POS Entry Mode ( ) CVV/CVC ( ) Thank you. CUNA Mutual Group. Scenario 3 : Case where there are no invalid transactions and but there are some cleansed transactions The following transactions have failed the Data Validation rules and have not been processed by CUNA Mutual Group. Please correct and resend all the Transactions under that account. The following transactions have failed the Data Validation rules. However, the invalid data has been set to default values in order to accept the transaction. 1) Account Number/Last Name AVS CVV2/CVC2/CID, AVS 2) Account Number/Last Name POS Entry Mode CVV/CVC Thank you. CUNA Mutual Group. Confidential Page 8 version 1.3

9 CLAIM AUTOMATION RECORD LAYOUT Card Processor (sender) to CUNA Mutual (receiver) Header Record Field Name Start End Length Format / Record Type Alphabetic H File Date and Numeric Time YYYYMMDDhhmmss H for header Data Validation Rules Date & Time File Created Less then equal to Current Date Example: Processor ID Alphanumeric Assigned by CUNA Mutual. Processor Name Alphanumeric, left justified, character space filled Filler Alphanumeric Used to identified transmission sender. Assigned by CUNA Mutual. If processor has multiple systems this field could be used to identity which system processed the fraud transaction Detail Records Fields noted as * (with an asterisk) may be optional. Please discuss with CUNA Mutual Group. Field Name Start End Length Format / Record Type Alphabetic D Record Numeric, right justified, zero Number filled Processor System Credit Union Identification Number Alphanumeric, left justified, character space filled D for Detail Data Validation Rules Number should be unique in the file Example: Name of the Processor s system. Allows the processor to tag what system the item processed making for faster issue resolution and tracking Numeric Assigned by CUNA Mutual. Primary sort field (see Requirements 7a) Matches the valid CUNA Mutual Customer Product Framework Organization Identifier (PFOID) on CMG s system. Example: CU Name Alphanumeric, left justified, character space filled. Credit Union Name BIN Number Numeric First 6 digits of Primary Account Number Secondary sort field (see Requirements 7b) ISO 8583 DE 2 Account Number Numeric Last 4 digits of Primary Account Number Third sort field (see Requirement 7c) ISO 8583 DE 2 Expiration Date Numeric Format: YYMM First Name Alphanumeric, left justified, character space filled Last Name Alphanumeric, left justified, character space filled * ISO 8583 DE 14 * * Cardholders first name Example: John<followed by 26 spaces> Cardholders last name Fourth sort field (see Requirements 7e) Example: Nelson<followed by 24 spaces> Confidential Page 9 version 1.3

10 Field Name Start End Length Format / Authorization Numeric : Date and Time YYYYMMDDhhmmss Date Authorization Amount Card Acceptor Country Code (If hhmmss if not available, zero fill) Numeric, right justified, zero filled Alphanumeric, left justified, character space filled : Time Data Validation Rules This field contains the month, day, year and time when the authorization took place at the card acceptor location. If authorization date is not available, use transaction date and time. (transaction date being defined as settlement date) Fifth sort field (see requirements 7e) Example: Less than equal to Current Date ISO 8583 DE 12, 13 This is the amount of the original transaction before any recovery (note: field 251 contains the net transaction amount that CUNA Mutual basis the claim). Sixth sort field (see Requirements 7f) Two decimal places are implied. Example: $ = Example: USA ISO 8583 DE 43 Card Type Numeric Valid Values: 1 = ATM 2 = Credit Card 3 = Debit Card 4 = Gift Card Card Brand & Card Type must all be same for a given card holder Card Brand Numeric Valid Values: 0 = Visa 1 = Master Card 2 = ATM 3 = Discover Card Brand & Card Type must all be same for a given cardholder Merchant Numeric Merchant Category Code Category Code Cardholder Discovery Date CU Discovery Date Numeric YYYYMMDD Numeric YYYYMMDD Approval Code Alphanumeric, left justified, character space filled ISO 8583 DE 18 Date the cardholder became aware (discovered) fraudulent activity. Less than equal to Current Date Example: Date the credit union (or processor) first received (notice) confirmation through , phone or otherwise of lost/stolen or unauthorized use of card that fraudulent activity occurred. Typically this is the date card was statused. Less then equal to Current Date Example: Authorization Code Seventh sort field (see Requirements 7g) ISO 8583 DE 38 Response Alphanumeric * Response Code Code ISO 8583 DE 39 Fraud Type Numeric Valid Values: 00 = Lost 01 = Stolen 02 = Card Not Received 03 = Application Fraud 04 = Counterfeit 05 = Account Takeover 06 = CNP MOTO 51 = MasterCard Bust out Card Blocked Alphabetic Valid Values: Confidential Page 10 version 1.3

11 Field Name Start End Length Format / POS Entry Mode POS Condition Code POS Cardholder Presence Data Validation Rules Y = Yes N = No Numeric Valid Values (ISO 8583 DE 22) : 00, 01, 02, 03, 04, 05, 07, 79, 80, 81, 90, 91, Alphanumeric Valid Values (VISA DE 25): 00, 02, 03, 05, 08, 51, 59, 71 Valid Value for MasterCard is Blank Alphanumeric Valid Value for VISA is Blank Valid Values for MasterCard (DE 61): 0, 1, 2, 3, 4, 5 CVV/CVC Alphanumeric Response Code: Visa valid values: Blank, 1, 2, 3 MasterCard valid values: 1, 2, 3, 4 ATM valid values: Blank, 1, 2 DISCOVER valid values: tbd CVV2/CVC2/C ID Alphanumeric Response Code: Valid Values are Blank, M, N, P, S, U AVS Alphanumeric Response Code Valid Values are Blank, X, Y, A, W, Z, N, U, R, E, S, D, M, B, P, C, I, G Electronic Commerce Indicator Alphanumeric VISA valid values: Blank, 1, 2, 3, 4, 5, 6, 7, 8, 9 MasterCard valid values: Blank, 1, 2 DISCOVER valid values: tbd CAVV/AAV Alphanumeric Result Code: VISA valid values Blank, 0, 1, 2, 3, 4, 6, 7, 8, 9, A, B, C, D MasterCard valid values: Blank, 0, 1, 2, 6 DISCOVER valid values: tbd Blank Compromised Event ID Alphanumeric Compromised Event Ref. ID. Found in Visa authorization message 62.22, byte 3 & 4. Valid Value for MasterCard & DISCOVER is Blank Bulletin Fee Numeric, right justified, zero filled. Reward Fee Numeric, right justified, zero filled. Net Transaction Loss Amount Numeric, right justified, zero filled. Two decimal places are implied. Example: $50.00 = If unknown, fill with Two decimal places are implied. Example: $50.00 = If unknown, fill with Example: $ = All claims are based on this value. This value is net of all recoveries Trailer Record Field Name Start End Length Format / Record Type Alphabetic T Record Count Numeric, right justified, zero filled T for trailer Data Validation Rules Total # of Detailed records Example: Total Amount Numeric, right justified, zero Total Amount in file based on Field 251. Confidential Page 11 version 1.3

12 Field Name Start End Length Format / Data Validation Rules filled Example: Filler Alphanumeric Confidential Page 12 version 1.3

13 Confidential Page 13 version 1.3