Segment
X12 EDI Release 00304
To identify information basic to the processing of any claims transaction
Elements
Code identifying the type of insurance policy within a specific insurance program
Codes (30)- 12Medicare Secondary Working Aged Beneficiary or Spouse with Employer Group Health Plan
- 13Medicare Secondary End-Stage Renal Disease Beneficiary in the Mandated Coordination Period with an Employer's Group Health Plan
- 14Medicare Secondary, No-fault Insurance including Auto is Primary
- 15Medicare Secondary Worker's Compensation
- 16Medicare Secondary Public Health Service (PHS)or Other Federal Agency
- 41Medicare Secondary Black Lung
- 42Medicare Secondary Veteran's Administration
- 43Medicare Secondary Disabled Beneficiary Under Age 65 with Large Group Health Plan (LGHP)
- APAuto Insurance Policy
- C1Commercial
- COConsolidated Omnibus Budget Reconciliation Act (COBRA)
- CPMedicare Conditionally Primary
- FFFamily or Friends
- GPGroup Policy
- HMHealth Maintenance Organization (HMO)
- IPIndividual Policy
- LDLong Term Policy
- LTLitigation
- MAMedicare Part A
- MBMedicare Part B
- MCMedicaid
- MG
- MPMedicare Primary
- OTOther
- PLPersonal
- PPPersonal Payment (Cash - No Insurance)
- PRPreferred Provider Organization (PPO)
- PSPoint of Service (POS)
- SPSupplemental Policy
- TFTax Equity Fiscal Responsibility Act (TEFRA)
Code indicating the date format, time format, or date and time format.
Codes (22)- CCFirst Two Digits of Year Expressed in Format CCYY
- CMDate in Format CCYYMM
- CYYear Expressed in Format CCYY
- D6Date Expressed in Format YYMMDD
- D8Date Expression in Format CCYYMMDD
- DDDay of Month in Numeric Format
- DTDate and Time Expressed in Format CCYYMMDDHHMM
- MDMonth of Year and Day of Month Expressed in Format MMDD
- ME
- MMMonth of Year in Numeric Format
- TMTime Expressed in Format HHMM
- TSTime Expressed in Format HHMMSS
- YMYear and Month Expressed in Format YYMM
- YYLast Two Digits of Year Expressed in Format CCYY
- RD2Range of Years Expressed in Format YY-YY
- RD4Range of Years Expressed in Format CCYY-CCYY
- RD6Range of Dates Expressed in Format YYMMDD-YYMMDD
- RD8Range of Dates Expressed in Format CCYYMMDD-CCYYMMDD
- RDMRange of Dates Expressed in Format YYMMDD-MMDD
- RDTRange of Date and Time, Expressed in Format CCYYMMDDHHMM-CCYYMMDDHHMM
- RMDRange of Months and Days Expressed in Format MMDD-MMDD
- RTMRange of Time Expressed in Format HHMM-HHMM
Code indicating the title or contents of a document, report or supporting item
Codes (258)- 11Chemical Analysis
- 12Mechanical Properties
- 13Certified Test Report
- 14Core Loss Test Report
- 20Process Plan
- 21Recovery Plan
- 22Functional Plan
- 23Contractual Plan
- 24Non-Contractual Plan
- 25Purchase Plan
- 26Production Plan
- 27Contract Delivery Schedule
- 28Master Delivery Schedule
- 29Assembly Plan
- 30Lead Time Chart
- 31Master Schedule
- 32Master Production Schedule
- 33Manufacturing Flow Diagram
- 34Lot Release Plan
- 35Subcontractor Plan
- 36Development Plan
- 01Product Transfer
- 02Resale
- AAAgent Inventory Report
- ABAssembly Drawing
- ACAssay Certificate
- ADAgent/Distributor Inventory Report
- AFAid Form
- AGActual
- AMAmbulance Certification
- AOAverage Outgoing Quality Report
- APAdvanced Problem Notification
- ASAdmission Summary
- ATPurchase Order Attachment
- AUAutomobile Claim Report
- AWAir Waybill
- BABudget
- BBBuy or Sell Exchange Contract Status Statement
- BCBill of Lading Copy
- BLBill of Lading
- BMBill of Material
- BNBeneficiary Certificate
- BOBill of Lading Original
- BSBaseline
- BTBlanket Test Results
- C1Cost Data Summary
- C2Functional Cost and Hour
- C3Progress Curve
- C4Plant-Wide Data
- CACertificate of Analysis
- CBChiropractic Justification
- CCC.A.A. Certificate of Conformance (British CAA)
- CDCustomer/Distributor Inventory Report
- CEConstable Report
- CGCertificate of Origin
- CHCertificate of Weight
- CICertificate of Inspection Report
- CLCable
- CMCustomer/Manufacturer Inventory Report
- CNCustomer's Report of Nonconformance
- COConsignment Order
- CPCertificate of Compliance (Material Certification)
- CQCounty Record
- CRLetter of Credit
- CSConsigned Inventory Sales Report
- CTCertification
- CUCustomer Notification Letter
- CWCorrective Work Order
- CXCost/Schedule Status Report (C/SSR)
- CYContract Funds Status Report (CFSR)
- CZCampus Police Report
- DADental Models
- DBDurable Medical Equipment Prescription
- DCDistributor/Customer Inventory Report
- DDDistributor Inventory Report
- DECertificate of Quality
- DFDA59 Special Customs Invoice for South Africa
- DGDiagnostic Report
- DHNitrogen Certificate
- DIDirectory
- DLDraft and Transmittal Letter
- DMDistributor/Manufacturer Inventory Report
- DNDeviation/Nonconformance Test Results and Request for Action
- DRDatalog Report
- DSDischarge Summary
- DTDepartment of Transportation
- DWDrawing(s)
- E1Exporter's Certificate and Agreement
- EAElectrical Average Outgoing Quality Report
- EBExplanation of Benefits (Coordination of Benefits or Medicare Secondary Payor)
- ECEngineering Change Order
- EPExperimental Material Purchase Order
- EREngineering Change Request
- EXShippers Export Declaration
- EYBarrel for Barrel Exchange Contract Status Statement
- F1Cost Performance Report (CPR) Format 1
- F2Cost Performance Report (CPR) Format 2
- F3Cost Performance Report (CPR) Format 3
- F4Cost Performance Report (CPR) Format 4
- F5Cost Performance Report (CPR) Format 5
- F6Transportation Carrier Inspection Report
- F7Government Inspection Report
- F8Inspection Waiver (Written)
- F9Inspection Waiver (Oral)
- FBFederal Bureau of Investigation
- FCFumigation Certificate
- FDFederal Specification Compliance
- FEFederal Emergency Management Agency
- FHLimitation of Heavy Elements
- FIFire Report
- FSCertificate of Free Sale
- HCHealth Certificate
- HRHealth Clinic Records
- I2Consular Invoice
- I3Customs Invoice
- I4Forwarder's Invoice
- IAInsurance Attachment
- ICInsurance Certificate
- IMImport License
- IPInventory Parameter Report
- IRState School Immunization Records
- ISIndex System
- ITCertified Inspection and Test Results
- IVInvoice
- KAContract Data Requirements List (CDRL)
- KCKosher Certificate
- LALaboratory Results
- LBLegalized Bill of Lading
- LCLocation Inventory Report
- LDLaboratory Quality Review Variation, Deviation
- LELatest Revised Estimate
- LGLegalized Certificate of Origin
- LILegalized Invoice
- LOLaboratory Quality Review Order, Waiver
- LPLabor Plan
- LRLaboratory Quality Review Order, Deviation
- LWLaboratory Quality Review Variation, Waiver
- MAManufacturer/Agent Inventory Report
- MBManufacturer/Distributor Inventory Report
- MCManufacturer/Customer Inventory Report
- MDMaterial Data Sheets
- MEMajor Deviation Request
- MFManufacturing Specification
- MGMigrant Student Records Transfer System (MSRTS) Record
- MIMortgage Insurance Certification
- MMManufacturer Inventory Report
- MNMinor Deviation Request
- MOManufacturer's Statement of Origin
- MRMaterial Inspection and Receiving Report
- MSMaterial Safety Data Sheet
- MTModels
- MVMetered Volumes
- NANational Insurance Crime Bureau Assignment
- NCCertificate of Quantity
- NDCommercial Invoice
- NINational Insurance Crime Bureau
- NLNational Insurance Crime Bureau Total Loss
- NNNursing Notes
- NONational Insurance Crime Bureau Other than Theft
- NTNational Insurance Crime Bureau Total Theft
- OBOperative Note
- OLOcean Bill of Lading
- OPOutside Production Operation Sheet
- OSOrganization Breakdown Structure
- OXOxygen Therapy Certification
- OZSupport Data for Claim
- P1Packing List
- PAPart Drawing
- PBProduct Catalog
- PCProcess Change Notice
- PDProof of Delivery
- PEParenteral or Enteral Certification
- PFProduct Specification
- PGPackaging Specification
- PHProduction History - Property Level
- PIProduct Availability Inquiry
- PJPurchasing Specification
- PKStorage Information Inquiry
- PLProperty Insurance Loss Register
- PNPhysical Therapy Notes
- POProsthetics or Orthotic Certification
- PRPurchase Report
- PSPipeline/Shipper Inventory Report
- PTInter-Plant Inventory Report
- PVPolice Report
- PWProduction History - Well Level
- PYPhysician's Report
- PZPhysical Therapy Certification
- QCCause and Corrective Action Report
- QDQuality Review Order, Purchasing
- QEQuality Detail
- QMQuality Review Order, Manufacturing
- QRQuality Report
- QSQuality Review Order Supplement
- QTQuality Summary
- RARevision Announcement
- RBRadiology Films
- RCRequest for Cause and Corrective Action Report
- RFReliability Fail Rate Report
- RMRequest for Manufacturing Engineer Appraisal
- RNSupplier's Report of Nonconformance
- RORegular Order
- RRRadiology Reports
- RTReport of Tests and Analysis Report
- S1Supply and Shipment Status Report
- S2Supply Status Report
- S3Exception Supply Status Report
- S4Exception Supply and Shipment Status Report
- S5Product Quality Deficiency Report Category I
- S6Product Quality Deficiency Report Category II
- S7"Walsh-Healey Act" Manufacturer or Regular Dealer
- S8Report of Findings
- S9Representation
- SAState Police Report
- SBSample Approval and Rejection List
- SCSanitary Certificate
- SDSupport Data for a Request for Quote
- SESecurity Police Report
- SHSheriff Report
- SISeller Inventory Report
- SLSample Bale List
- SMShipping Manifests
- SNShipping Notice
- SPSpecification
- SQStatistical Quality Documents
- SRStatistical Report
- SSSeller Sales Report
- STStudent Educational Record (Transcript)
- SUSupplier's Certificate
- SWSea Waybill
- TAAsset Support Inquiry
- TBAsset Support Advice
- TCPhysical Inventory Request
- TDAsset Reclassification Response
- TEAsset Reclassification Request
- TFTransaction History Request
- THTotal Theft Claim Report
- TIAsset Status Inquiry
- TJAsset Status Advice
- TKLogistics Transfer Inquiry
- TLLogistics Transfer Advice
- TMStock Sale Report
- TNDelayed Sale Report
- TODemand Report
- TPTreatments Certificate
- TQStorage Information Advice
- TRTransmittal Letter
- TTTitle Transfer
- U1Survey Report
- US"BUY AMERICA" Certification of Compliance
- VAVariance Analysis
- VDData Request for Vendor's Specifications or Drawings.
- VMVisual/Mechanical Average Outgoing Quality Report
- WBWork Breakdown Structure
- WIWell Information
- WPWork Progress
- WTWell Test Information
- ZBConventional Ammunition Suspension Report