Segment
X12 EDI Release 00402
To supply information common to all services of a claim
Elements
Code identifying the status of an entire claim as assigned by the payor, claim review organization or repricing organization
Codes (41)- 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
- 25Predetermination Pricing Only - No Payment
- 26Documentation Claim - No Payment Associated
- 27Reviewed
- 28Repriced
- 29Audited
- 30Processed as Conditional
- IInitial
- ADAdditional
- APAppealed
- CCWeekly Certification
- CLClosed
- CPOpen
- RAReaudited
- RBReissue
- RCReopened and Closed
- RDRedetermination
- ROReopened
Code identifying type of claim
Codes (45)- 10Central Certification
- 11Other Non-Federal Programs
- 12Preferred Provider Organization (PPO)
- 13Point of Service (POS)
- 14Exclusive Provider Organization (EPO)
- 15Indemnity Insurance
- 16Health Maintenance Organization (HMO) Medicare Risk
- 17Dental Maintenance Organization
- 18Deed-in-Lieu Property Sold
- 19Deed-in-Lieu Property Not Sold
- 20Foreclosure Complete Property Sold
- 21Foreclosure Complete Property Not Sold
- 22Liability Insurance
- 01Property Conveyance
- 02Mortgage Assignment
- 03Automatic Mortgage Assignment
- 04Mortgage Coinsurance
- 05Supplemental Claim
- 06Property Nonconveyance (Claim without Conveyance of Title)
- 07Property Preforeclosure Sale
- 08Initial Claim
- 09Self-pay
- AMAutomobile Medical
- BLBlue Cross/Blue Shield
- CHChampus
- CICommercial Insurance Co.
- CNContractual
- DSDisability
- FIFederal Employees Program
- HMHealth Maintenance Organization
- LILiability
- LMLiability Medical
- MAMedicare Part A
- MBMedicare Part B
- MCMedicaid
- MHManaged Care Non-HMO
- OFOther Federal Program
- SASelf-administered Group
- TVTitle V
- VAVeterans Affairs Plan
- WBWorkers' Compensation First Report of Injury
- WCWorkers' Compensation Health Claim
- WDWorkers' Compensation Subsequent Report of Injury
- WEWorkers' Compensation Combined First and Subsequent Report
- ZZMutually Defined