Segment
X12 EDI Release 00304
To indicate the status of a claim for mortgage insurance benefits
Elements
Code identifying reason for claim submission
Codes (15)- 15Resubmission
- 16Proposed
- 17Cancel to be Reissued
- 18Reissue
- 20Final Transmission
- 22Information Copy
- 27Verify
- 28Late Charges
- 29Adjustment
- 00Original
- 01Cancellation
- 02Corrected and Verified Original Claim
- 03Corrected and Verified Final Claim
- 05Replace
- 07Duplicate
Code specifying type of date or time, or both date and time.
Codes (601)- 100No Shipping Schedule Established as of
- 101No Production Schedule Established as of
- 102Issue
- 103Award
- 104System Survey
- 105Quality Rating
- 106Required By
- 107Deposit
- 108Postmark
- 109Received at Lockbox
- 110Originally Scheduled Ship
- 111Manifest/Ship Notice
- 112Buyers Dock
- 113Sample Required
- 114Tooling Required
- 115Sample Available
- 116Scheduled Interchange Delivery
- 118Requested Pickup
- 119Test Performed
- 120Control Plan
- 121Feasibility Sign Off
- 122Failure Mode Effective
- 124Group Contract Effective
- 125Group Contract Expiration
- 126Wholesale Contract Effective
- 127Wholesale Contract Expiration
- 128Replacement Effective
- 129Customer Contract Effective
- 130Customer Contract Expiration
- 131Item Contract Effective
- 132Item Contract Expiration
- 133Accounts Receivable - Statement Date
- 134Ready for Inspection
- 135Booking
- 136Technical Rating
- 137Delivery Rating
- 138Commercial Rating
- 139Estimated
- 140Actual
- 141Assigned
- 142Loss
- 143Due Date of First Payment to Principal and Interest
- 144Estimated Acceptance
- 145Opening Date
- 146Closing Date
- 147Due Date Last Complete Installment Paid
- 148Date of Local Office Approval of Conveyance of Damaged Real Estate Property
- 149Date Deed Filed for Record
- 150Service Period Start
- 151Service Period End
- 152Effective Date of Change
- 153Service Interruption
- 154Adjustment Period Start
- 155Adjustment Period End
- 156Allotment Period Start
- 157Test Period Start
- 158Test Period Ending
- 159Bid Price Exception
- 160Samples to be Returned By
- 161Loaded on Vessel
- 162Pending Archive
- 163Actual Archive
- 164First Issue
- 165Final Issue
- 166Message
- 167Most Recent Revision (or Initial Version)
- 168Release
- 169Product Availability Date
- 170Supplemental Issue
- 171Revision
- 172Correction
- 173Week Ending
- 174Month Ending
- 175Cancel if not shipped by
- 176Expedited on
- 177Cancellation
- 178Hold (as of)
- 179Hold as Stock (as of)
- 180No Promise (as of)
- 181Stop Work (as of)
- 182Will Advise (as of)
- 183Connection
- 184Inventory
- 185Vessel Registry
- 186Invoice Period Start
- 187Invoice Period End
- 188Credit Advice
- 189Debit Advice
- 190Released to Vessel
- 191Material Specification
- 192Delivery Ticket
- 193Period Start
- 194Period End
- 195Contract Re-Open
- 196Start
- 197End
- 198Completion
- 199Seal
- 200Assembly Start
- 201Acceptance
- 202Master Lease Agreement
- 203First Produced
- 204Official Rail Car Interchange (Either Actual or Agreed Upon)
- 206Status (Outside Processor)
- 207Status (Commercial)
- 208Lot Number Expiration
- 209Contract Performance Start
- 210Contract Performance Delivery
- 211Service Requested
- 212Returned to Customer
- 213Adjustment to Bill Dated
- 214Date of Repair/Service
- 215Interruption Start
- 216Interruption End
- 217Spud
- 218Initial Completion
- 219Plugged and Abandoned
- 220Penalty
- 221Penalty Begin
- 222Birth
- 223Birth Certificate
- 224Adoption
- 225Christening
- 226Lease Commencement
- 227Lease Term Start
- 228Lease Term End
- 229Rent Start
- 230Installation
- 231Progress Payment
- 232Claim Statement Period Start
- 233Claim Statement Period End
- 234Settlement Date
- 235Delayed Billing (Not Delayed Payment)
- 236Lender Credit Check
- 237Student Signed
- 238Schedule Release
- 239Baseline
- 240Baseline Start
- 241Baseline Complete
- 242Actual Start
- 243Actual Complete
- 244Estimated Start
- 245Estimated Completion
- 246Start no earlier than
- 247Start no later than
- 248Finish no later than
- 249Finish no earlier than
- 250Mandatory (or Target) Start
- 251Mandatory (or Target) Finish
- 252Early Start
- 253Early Finish
- 254Late Start
- 255Late Finish
- 256Scheduled Start
- 257Scheduled Finish
- 258Original Early Start
- 259Original Early Finish
- 260Rest Day
- 261Rest Start
- 262Rest Finish
- 263Holiday
- 264Holiday Start
- 265Holiday Finish
- 266Base
- 267Timenow
- 268End Date of Support
- 269Date Account Matures
- 270Date Filed
- 271Penalty End
- 272Exit Plant Date
- 273Latest On Board Carrier Date
- 274Requested Departure Date
- 275Approved
- 276Contract Start
- 277Contract Definition
- 278Last Item Delivery
- 279Contract Completion
- 280Date Course of Orthodontics Treatment Began or is Expected to Begin
- 281Over Target Baseline Month
- 282Previous Report
- 283Funds Appropriation - Start
- 284Funds Appropriation - End
- 285Employment or Hire
- 286Retirement
- 287Medicare
- 288Consolidated Omnibus Budget Reconciliation Act (COBRA)
- 289Premium Paid to Date
- 290Coordination of Benefits
- 291Plan
- 292Benefit
- 293Education
- 294Earnings Effective Date
- 295Primary Care Provider
- 296Initial Disability Period Return To Work
- 297Initial Disability Period Last Day Worked
- 298Latest Absence
- 299Illness
- 300Enrollment Signature Date
- 301Consolidated Omnibus Budget Reconciliation Act (COBRA) Qualifying Event
- 302Maintenance
- 303Maintenance Effective
- 304Latest Visit or Consultation
- 305Net Credit Service Date
- 306Adjustment Effective Date
- 307Eligibility
- 309Plan Termination
- 310Date of Closing
- 311Latest Receiving Date/Cutoff Date
- 312Salary Deferral
- 313Cycle
- 314Disability
- 315Offset
- 316Prior Incorrect Date of Birth
- 317Corrected Date of Birth
- 319Failed
- 320Date Foreclosure Proceedings Instituted
- 321Purchased
- 322Put into Service
- 323Replaced
- 324Returned
- 327Quarter Ending
- 328Changed
- 329Terminated
- 330Referral Date
- 331Evaluation Date
- 332Placement Date
- 333Individual Education Plan (IEP)
- 334Re-evaluation Date
- 335Dismissal Date
- 336Employment Begin
- 337Employment End
- 338Medicare Begin
- 339Medicare End
- 340Consolidated Omnibus Budget Reconciliation Act (COBRA) Begin
- 341Consolidated Omnibus Budget Reconciliation Act (COBRA) End
- 342Premium Paid to Date Begin
- 343Premium Paid to Date End
- 344Coordination of Benefits Begin
- 345Coordination of Benefits End
- 346Plan Begin
- 347Plan End
- 348Benefit Begin
- 349Benefit End
- 350Education Begin
- 351Education End
- 352Primary Care Provider Begin
- 353Primary Care Provider End
- 354Illness Begin
- 355Illness End
- 356Eligibility Begin
- 357Eligibility End
- 358Cycle Begin
- 359Cycle End
- 360Initial Disability Period Start
- 361Initial Disability Period End
- 362Offset Begin
- 363Offset End
- 364Plan Period Election Begin
- 365Plan Period Election End
- 366Plan Period Election
- 367Due to Customer
- 368Submittal
- 369Estimated Departure Date
- 370Actual Departure Date
- 371Estimated Arrival Date
- 372Actual Arrival Date
- 373Order Start
- 374Order End
- 375Delivery Start
- 376Delivery End
- 377Contract Costs Through
- 378Financial Information Submission
- 379Business Termination
- 380Applicant Signed
- 381Cosigner Signed
- 382Enrollment
- 383Adjusted Hire
- 384Credited Service
- 385Credited Service Begin
- 386Credited Service End
- 387Deferred Distribution
- 388Payment Commencement
- 389Payroll Period
- 390Payroll Period Begin
- 391Payroll Period End
- 392Plan Entry
- 393Plan Participation Suspension
- 394Rehire
- 395Retermination
- 396Termination
- 397Valuation
- 398Vesting Service
- 399Vesting Service Begin
- 400Vesting Service End
- 401Duplicate Bill
- 402Adjustment Promised
- 403Adjustment Processed
- 404Year Ending
- 405Production
- 406Material Classification
- 408Weighed
- 409Date of Deed in Lieu
- 410Date of Firm Commitment
- 411Expiration Date of Extension to Foreclose
- 412Date of Notice to Convey
- 413Date of Release of Bankruptcy
- 414Optimistic Early Start
- 415Optimistic Early Finish
- 416Optimistic Late Start
- 417Optimistic Late Finish
- 418Most Likely Early Start
- 419Most Likely Early Finish
- 420Most Likely Late Start
- 421Most Likely Late Finish
- 422Pessimistic Early Start
- 423Pessimistic Early Finish
- 424Pessimistic Late Start
- 425Pessimistic Late Finish
- 426First Payment Due
- 427First Interest Payment Due
- 428Subsequent Interest Payment Due
- 429Irregular Interest Payment Due
- 430Guarantor Received
- 431Onset of Current Symptoms or Illness
- 432Submission
- 434Statement
- 435Admission
- 436Insurance Card
- 437Spouse Retirement
- 438Onset of Similar Symptoms or Illness
- 439Accident
- 440Release of Information
- 441Prior Placement
- 442Date of Death
- 443Peer Review Organization (PRO) Approved Stay
- 444First Visit or Consultation
- 445Initial Placement
- 446Replacement
- 447Occurrence
- 448Occurrence Span
- 449Occurrence Span From
- 450Occurrence Span To
- 451Initial Fee Due
- 452Appliance Placement
- 453Acute Manifestation of a Chronic Condition
- 454Initial Treatment
- 455Last X-Ray
- 456Surgery
- 457Continuous Passive Motion (CPM)
- 458Certification
- 459Nursing Home From
- 460Nursing Home To
- 461Last Certification
- 462Date of Local Office Approval of Conveyance of Occupied Real Estate Property
- 463Begin Therapy
- 464Oxygen Therapy From
- 465Oxygen Therapy To
- 466Oxygen Therapy
- 467Signature
- 468Prescription Fill
- 469Provider Signature
- 470Date of Local Office Certification of Conveyance of Damaged Real Estate Property
- 471Prescription
- 472Service
- 473Medicaid Begin
- 474Medicaid End
- 475Medicaid
- 476Peer Review Organization (PRO) Approved Stay From
- 477Peer Review Organization (PRO) Approved Stay To
- 478Prescription From
- 479Prescription To
- 480Arterial Blood Gas Test
- 481Oxygen Saturation Test
- 482Pregnancy Begin
- 483Pregnancy End
- 484Last Menstrual Period
- 485Injury Begin
- 486Injury End
- 487Nursing Home
- 488Collateral Dependent
- 489Collateral Dependent Begin
- 490Collateral Dependent End
- 491Sponsored Dependent
- 492Sponsored Dependent Begin
- 493Sponsored Dependent End
- 494Deductible
- 495Out-of-Pocket
- 496Contract Audit Date
- 497Latest Delivery Date at Pier
- 498Mortgagee Reported Curtailment Date
- 499Mortgagee Official Signature Date
- 500Resubmission
- 501Expected Reply
- 502Dropped to Less than Half Time
- 503Repayment Begin
- 504Loan Servicing Transfer
- 505Loan Purchase
- 506Last Notification
- 507Extract
- 508Extended
- 509Servicer Signature Date
- 510Date Packed
- 511Shelf Life Expiration
- 512Warranty Expiration
- 513Overhauled
- 514Transferred
- 515Notified
- 516Discovered
- 517Inspected
- 518Voucher (Date of)
- 519Date Bankruptcy Filed
- 520Date of Damage
- 521Date Hazard Insurance Policy Cancelled
- 522Expiration Date to Submit Title Evidence
- 523Date of Claim
- 524Date of Notice of Referral for Assignment
- 525Date of Notice of Probable Ineligibility for Assignment
- 526Date of Foreclosure Notice
- 527Expiration of Foreclosure Timeframe
- 528Date Possessory Action Initiated
- 529Date of Possession
- 531Date of Acquisition of Title
- 532Expiration of Extension to Convey
- 533Date of Assignment Approval
- 534Date of Assignment Rejection
- 535Curtailment Date from Advice of Payment
- 536Expiration of Extension to Submit Fiscal Data
- 537Date Documentation, or Paperwork, or Both Was Sent
- 538Makegood Commercial Date
- 539Policy Effective
- 540Policy Expiration
- 541Employee Effective Date of Coverage
- 542Claim Administrator Notified of Employee Legal Representation
- 543Last Premium Paid Date
- 544Employer Knowledge of the Injury
- 545Claim Administrator Knowledge of the Injury
- 546Date of Maximum Medical Improvement
- 547Date of Loan
- 548Date of Advance
- 549Beginning Lay Date
- 550Certificate Effective
- 551Benefit Application Date
- 552Actual Return to Work
- 553Released Return to Work
- 554Ending Lay Date
- 555Employee Wages Ceased
- 556Last Salary Increase
- 557Employee Laid Off
- 558Injury or Illness
- 559Oldest Unpaid Installment
- 560Preforeclosure Acceptance Date
- 561Preforeclosure Sale Closing Date
- 562Date of First Uncured Default
- 563Date Default Was Cured
- 564Date of First Mortgage Payment
- 565Date of Property Inspection
- 566Date Total Amount of Delinquency Reported
- 567Date Outstanding Loan Balance Reported
- 568Date Foreclosure Sale Scheduled
- 569Date Foreclosure Held
- 570Date Redemption Period Ends
- 571Date Voluntary Conveyance Accepted
- 572Date Property Sold
- 573Date Claim Paid
- 574Action Begin Date
- 575Projected Action End Date
- 576Action End Date
- 577Original Maturity Date
- 578Date Referred to Attorney for Foreclosure
- 579Planned Release
- 580Actual Release
- 581Contract Period
- 582Report Period
- 583Suspension
- 584Reinstatement
- 585Report
- 586First Contact
- 587Projected Foreclosure Sale Date
- 589Date Assignment Filed for Record
- 590Date of Appraisal
- 591Expiration Date of Extension to Assign
- 592Date of Extension to Convey
- 593Date Hazard Insurance Policy Refused
- 594High Fabrication Release Authorization
- 595High Raw Material Authorization
- 596Material Change Notice
- 597Latest Delivery Date at Rail Ramp
- 598Rejected
- 600As Of
- 601First Submission
- 602Subsequent Submission
- 700Override Date for Settlement
- 701Settlement Date (From Interline Settlement System (ISS) only)
- 702Sending Road Time Stamp
- 703Retransmission Time Stamp
- 704Delivery Appointment Date and Time
- 706Date Material Usage Suspended
- 993Request for Quotation
- 994Quote
- 996Required Delivery
- 997Quote to be Received By
- 001Cancel After
- 002Delivery Requested
- 003Invoice
- 004Purchase Order
- 005Sailing
- 006Sold
- 007Effective
- 008Purchase Order Received
- 009Process
- 010Requested Ship
- 011Shipped
- 012Terms Discount Due
- 013Terms Net Due
- 014Deferred Payment
- 015Promotion Start
- 016Promotion End
- 017Estimated Delivery
- 018Available
- 019Unloaded
- 020Check
- 021Charge Back
- 022Freight Bill
- 023Promotion Order - Start
- 024Promotion Order - End
- 025Promotion Ship - Start
- 026Promotion Ship - End
- 027Promotion Requested Delivery - Start
- 028Promotion Requested Delivery - End
- 029Promotion Performance - Start
- 030Promotion Performance - End
- 031Promotion Invoice Performance - Start
- 032Promotion Invoice Performance - End
- 033Promotion Floor Stock Protect - Start
- 034Promotion Floor Stock Protect - End
- 035Delivered
- 036Expiration
- 037Ship Not Before
- 038Ship No Later
- 039Ship Week of
- 040Status (After and Including)
- 041Status (Prior and Including)
- 042Superseded
- 043Publication
- 044Settlement Date as Specified by the Originator
- 045Endorsement Date
- 046Field Failure
- 047Functional Test
- 048System Test
- 049Prototype Test
- 050Received
- 051Cumulative Quantity Start
- 052Cumulative Quantity End
- 053Buyers Local
- 054Sellers Local
- 055Confirmed
- 056Estimated Port of Entry
- 057Actual Port of Entry
- 058Customs Clearance
- 059Inland Ship
- 060Engineering Change Level
- 061Cancel if Not Delivered by
- 062Blueprint
- 063Do Not Deliver After
- 064Do Not Deliver Before
- 0651st Schedule Delivery
- 0661st Schedule Ship
- 067Current Schedule Delivery
- 068Current Schedule Ship
- 069Promised for Delivery
- 070Scheduled for Delivery (After and Including)
- 071Requested for Delivery (After and Including)
- 072Promised for Delivery (After and Including)
- 073Scheduled for Delivery (Prior to and Including)
- 074Requested for Delivery (Prior to and Including)
- 075Promised for Delivery (Prior to and Including)
- 076Scheduled for Delivery (Week of)
- 077Requested for Delivery (Week of)
- 078Promised for Delivery (Week of)
- 079Promised for Shipment
- 080Scheduled for Shipment (After and Including)
- 081Requested for Shipment (After and Including)
- 082Promised for Shipment (After and Including)
- 083Scheduled for Shipment (Prior to and Including)
- 084Requested for Shipment (Prior to and Including)
- 085Promised for Shipment (Prior to and Including)
- 086Scheduled for Shipment (Week of)
- 087Requested for Shipment (Week of)
- 088Promised for Shipment (Week of)
- 089Inquiry
- 090Report Start
- 091Report End
- 092Contract Effective
- 093Contract Expiration
- 094Manufacture
- 095Bill of Lading
- 096Discharge
- 097Transaction Creation
- 098Bid (Effective)
- 099Bid Open (Date Bids Will Be Opened)
- ZZZMutually Defined
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
