Segment
X12 EDI Release 00304
To convey the status of a product service claim or claims or to supply adjustment reason codes and amounts as needed for an entire claim or for a particular item within the claim
Elements
Code identifying the status of an entire claim as assigned by the payor.
Codes (28)- 1Processed as Primary
- 2Processed as Secondary
- 3Processed as Tertiary
- 4Denied
- 5Pended
- 6Approved as amended
- 7Approved as submitted
- 8Cancelled due to inactivity
- 9Pending - under investigation
- 10Received, but not in process
- 11Rejected, duplicate claim
- 12Rejected, please resubmit with corrections
- 13Suspended
- 14Suspended - incomplete claim
- 15Suspended - investigation with field
- 16Suspended - return with material
- 17Suspended - review pending
- 18Suspended Product Registration
- 19Processed as Primary, Forwarded to Additional Payer(s)
- 20Processed as Secondary, Forwarded to Additional Payer(s)
- 21Processed as Tertiary, Forwarded to Additional Payer(s)
- 22Reversal of Previous Payment
- 23Not Our Claim, Forwarded to Additional Payer(s)
- 24Transferred to Proper Carrier
- CLClosed
- CPOpen
- RCReopened and Closed
- ROReopened
Code identifying the agency assigning the code values.
Codes (80)- 94Code Assigned by the Organization that is the Ultimate Destination of the Transaction Set
- AAAluminum Association
- ABAssigned by Buyer
- ACAmerican Conference of Government Industrial Hygienists (ACGIH)
- ADAgency Company Organization for Research and Development (ACORD)
- AEAdvertising Industry
- AHAmerican Industrial Hygiene Association (AIHA)
- AI
- APAmerican Petroleum Institute
- ASAssigned by Seller
- ATAmerican Society for Testing and Materials (ASTM)
- AWAmerican Welding Society (AWS)
- AXANSI Accredited Standards Committee, X12
- BETelcordia Technologies
- BFNational Business Forms Association
- BIBook Industry Systems Advisory Committee
- CAChemical Abstract Services (CAS)
- CBCopper and Brass Fabricators Council, Inc.
- CCNational Cotton Council of America
- CIChemical Industry Data Exchange (CIDX)
- CMCarbide Manufacturers
- CRCommander - Rome Air Development Center
- CXNational Association of Corrosion Engineers (NACE)
- DAFood and Drug Administration (FDA)
- DDDepartment of Defense (Military Specifications)
- DEDrug Enforcement Administration
- DIDeutsches Institut fur Normung (DIN)
- DOUnited States Department of Transportation (DOT)
- DRHealthcare Distribution Management Association
- EIElectronic Industries Association
- EPUnited States Environmental Protection Agency (EPA)
- ESEnvironment and Safety Data Exchange (ESDX)
- EUElectric Utilities
- EXElectronics Industry Data Exchange (EIDX)
- FAFabric and Supplier Linkage Council (FASLINC)
- FDGS1 US, Inc.
- FIAmerican Furniture Manufacturers Association
- GCGraphics Communications Association
- GSGeneral Services Administration (GSA)
- GUNatural Gas Utilities
- HCCenters for Medicare and Medicaid Services
- HIHealth Insurance Association of America
- IAInternational Agency for Research on Cancer (IARC)
- IMIron and Steel Standards Committee ISM
- ISInternational Standards Organization
- JAJapanese Standards Association
- LILeasing Industry
- MBOffice of Management and Budget
- MCManufacturing Company
- MEAmerican Society of Mechanical Engineers (ASME)
- MIABCD - The Microcomputer Industry Association
- MPMaterial Safety Data Sheet (MSDS) Provider
- MSMilitary Standard
- NANational Insurance Crime Bureau (NICB)
- NENational Electric Manufacturers Association (NEMA)
- NFNational Fire Protection Agency (NFPA)
- NINational Institute of Occupational Safety and Health (NIOSH)
- NRNational Retail Merchants Association
- NTNational Toxicology Program (NTP)
- NWNewspaper Association of America
- OPOffice Products
- OSUnited States Occupational Safety and Health Administration (OSHA)
- PAAmerican Paper Institute
- SASociety of Automotive Engineers, Inc. (SAE)
- SESerials Industry Systems Advisory Committee (SISAC)
- SLStudent Loan Guarantor
- SPAmerican Society for Automation in Pharmacy
- STAmerican Iron & Steel Institute
- TAAir Transport Association of America
- TBTextile Distributors Association, Inc.
- TCTextile Apparel Linkage Council (TALC)
- TDTransportation Data Coordinating Committee: Electronic Data Interchange Association (TDCC:EDIA)
- TITelecommunications Industry
- TMAmerican Textile Manufacturers Institute
- TRAmerican Trucking Associations
- TXAmerican Apparel Manufacturers Association
- UNUnited Nations (UN)
- VIVoluntary Inter-Industry Commerce Standard (VICS) EDI
- WHCanadian Workplace Hazardous Materials Information System (WHMIS)
- ZZMutually Defined
Code identifying the detailed reason for the response
Codes (26)- DCDuplicate Charge
- EWExpired Warranty
- URUnauthorized Repair
- CDRCustomer Damage or Responsibility
- CMPCustomer Must Pay Deductible
- ELHExcessive Labor Hours
- ELRExcessive Labor Rate
- EPCExcessive Part Cost
- FRSFactory Required Service
- FWCFull Warranty Credit
- IISInsufficient Information Supplied
- IRSItem Reported as Stolen
- IWSInsufficient Warranty Information Supplied
- MAPManufacturer's Agreed Price
- NCRNo Charge Repair
- NEWNot Eligible for Warranty
- NOPNot Our Product
- NRINot a Recall Item
- NSBNot a Service Bulletin Item
- NWRNo Warranty Record
- PNPPart not Proper for Specified Repair
- PWAPartial Warranty Approved
- RDPRepair Description Does Not Agree With Product
- UPRUnrelated To Previous Repair
- URFUnauthorized Repair Facility
- WBSWarranted By Seller
Code identifying follow-up actions allowed.
Codes (9)- CPlease Correct and Resubmit
- DResubmit Entire Claim
- EResubmit This Item Only
- NResubmission Not Allowed
- PPlease Resubmit Original Transaction
- RResubmission Allowed
- WPlease Wait 30 Days and Resubmit
- XPlease Wait 10 Days and Resubmit
- YDo Not Resubmit; We Will Hold Your Request and Respond Again Shortly
Code identifying the agency assigning the code values.
Codes (80)- 94Code Assigned by the Organization that is the Ultimate Destination of the Transaction Set
- AAAluminum Association
- ABAssigned by Buyer
- ACAmerican Conference of Government Industrial Hygienists (ACGIH)
- ADAgency Company Organization for Research and Development (ACORD)
- AEAdvertising Industry
- AHAmerican Industrial Hygiene Association (AIHA)
- AI
- APAmerican Petroleum Institute
- ASAssigned by Seller
- ATAmerican Society for Testing and Materials (ASTM)
- AWAmerican Welding Society (AWS)
- AXANSI Accredited Standards Committee, X12
- BETelcordia Technologies
- BFNational Business Forms Association
- BIBook Industry Systems Advisory Committee
- CAChemical Abstract Services (CAS)
- CBCopper and Brass Fabricators Council, Inc.
- CCNational Cotton Council of America
- CIChemical Industry Data Exchange (CIDX)
- CMCarbide Manufacturers
- CRCommander - Rome Air Development Center
- CXNational Association of Corrosion Engineers (NACE)
- DAFood and Drug Administration (FDA)
- DDDepartment of Defense (Military Specifications)
- DEDrug Enforcement Administration
- DIDeutsches Institut fur Normung (DIN)
- DOUnited States Department of Transportation (DOT)
- DRHealthcare Distribution Management Association
- EIElectronic Industries Association
- EPUnited States Environmental Protection Agency (EPA)
- ESEnvironment and Safety Data Exchange (ESDX)
- EUElectric Utilities
- EXElectronics Industry Data Exchange (EIDX)
- FAFabric and Supplier Linkage Council (FASLINC)
- FDGS1 US, Inc.
- FIAmerican Furniture Manufacturers Association
- GCGraphics Communications Association
- GSGeneral Services Administration (GSA)
- GUNatural Gas Utilities
- HCCenters for Medicare and Medicaid Services
- HIHealth Insurance Association of America
- IAInternational Agency for Research on Cancer (IARC)
- IMIron and Steel Standards Committee ISM
- ISInternational Standards Organization
- JAJapanese Standards Association
- LILeasing Industry
- MBOffice of Management and Budget
- MCManufacturing Company
- MEAmerican Society of Mechanical Engineers (ASME)
- MIABCD - The Microcomputer Industry Association
- MPMaterial Safety Data Sheet (MSDS) Provider
- MSMilitary Standard
- NANational Insurance Crime Bureau (NICB)
- NENational Electric Manufacturers Association (NEMA)
- NFNational Fire Protection Agency (NFPA)
- NINational Institute of Occupational Safety and Health (NIOSH)
- NRNational Retail Merchants Association
- NTNational Toxicology Program (NTP)
- NWNewspaper Association of America
- OPOffice Products
- OSUnited States Occupational Safety and Health Administration (OSHA)
- PAAmerican Paper Institute
- SASociety of Automotive Engineers, Inc. (SAE)
- SESerials Industry Systems Advisory Committee (SISAC)
- SLStudent Loan Guarantor
- SPAmerican Society for Automation in Pharmacy
- STAmerican Iron & Steel Institute
- TAAir Transport Association of America
- TBTextile Distributors Association, Inc.
- TCTextile Apparel Linkage Council (TALC)
- TDTransportation Data Coordinating Committee: Electronic Data Interchange Association (TDCC:EDIA)
- TITelecommunications Industry
- TMAmerican Textile Manufacturers Institute
- TRAmerican Trucking Associations
- TXAmerican Apparel Manufacturers Association
- UNUnited Nations (UN)
- VIVoluntary Inter-Industry Commerce Standard (VICS) EDI
- WHCanadian Workplace Hazardous Materials Information System (WHMIS)
- ZZMutually Defined