Segment
X12 EDI Release 00403
To specify the outcome of a health care services review
Elements
Code indicating type of action
Codes (311)- 1Add
- 2Change (Update)
- 3Delete
- 4Verify
- 5Send
- 6Receive
- 7Request
- 8In Production Send
- 9Not Capable of Taking Action
- 10Adjourn
- 11Approve
- 12Auction
- 13Cleared
- 14Compose
- 15Correct and Resubmit Claim
- 16Consider
- 17Create
- 18Decide
- 19Declare
- 20Decree Recall
- 21Disapprove
- 22Dissolve
- 23Escalation
- 24On-Hold
- 25Dropped
- 26Bankruptcy Filed - Review Account
- 27Moved - Follow Up
- 28Change Phone Number
- 29Payment Received - Follow Up
- 30Account Active - Pursue
- 31Return per Client Request
- 32Pursue Legal Action
- 33Active
- 34Pursue Garnishment
- 35New Assignment - Proceed
- 36Repossess Merchandise
- 37Adjust Payment
- 38Change Address
- 39Skiptrace Account
- 40Close Account - Deceased
- 41Update to Inactive
- 42Account Paid in Full - Close Account
- 43Refused to Pay - Review Account
- 44Account Disputed - Review
- 45Do Not Contact - Fair Debt Collection Practices Act (FDCPA)
- 46Forward Account
- 47Enforce
- 48Extinguish
- 49Judgment for Defendant
- 50Judgment for Plaintiff
- 51Complete
- 52Justified
- 53Legal Moratorium on Debts Incurred to Date
- 54Meeting Held
- 55Meeting Held and Opened
- 56Moratorium
- 57Not Filed
- 58Not Justified
- 59Partial Release
- 60Provisional Moratorium
- 61Readjudicate
- 62Resolve
- 63Resulted in a Suit
- 64Resulted in No Liquidation
- 65Set Aside
- 66Settled out of Court
- 67Sold
- 68Stayed
- 69Subordination
- 70Surrender
- 71Term Expired
- 72Unsatisfied
- 73Void
- 74Suspended, 24 Hours
- 75Dispute
- 76Assign
- 77Agent Change
- 78Agent Hierarchy Change
- 79Reactivate
- 80Reconcile
- 81Renew
- 82Follow Up
- 83Future
- 84Letter of Authority Sent
- 85New Premium Only
- 86Pended for Follow Up
- 87Countersue
- 88Contact via Telephone Call
- 89Contact via Fax
- 90Mark
- 91In Progress
- 92Reconfirm
- AAdd A Bill of Lading
- BCancel Balance of Order/Item that Exceeds Value Specified in Data Element 610
- CCancelled
- DDelete a Bill of Lading
- EEliminate/Expire
- FFinal
- GCancel Entire Order/Item
- HMaster-In-Bond (MIB) Arrival
- IReissue
- JRecord
- KIn Production Send and Receive
- LIn Development/Send
- MIn Development/Receive
- NIn Development/Send and Receive
- OIn Test/Send
- PIn Test/Receive
- QIn Test/Send and Receive
- RIn Production Receive
- SRe-record
- TStatus Query
- UReject
- VRespond
- WReverse
- XRecommend
- YNot Recommend
- ZMutually Defined
- A1Certified in total
- A2Certified - partial
- A3Not Certified
- A4Pended
- A5Upheld
- A6Modified
- AAAward
- ABAbandon
- ACAcknowledge
- ADDecrease in Amount
- AEActivate
- AFAffirm
- AGAdded Commodity Codes
- AHAdded Equipment
- AIIncrease in Amount
- AJAdded Points Served
- ALAllow
- APAppeal
- AQAcquitted
- ARAdvanced Payment
- ASDiscovered
- ATAppoint
- AVCancellation Not Effected
- AWMass Cancellation
- AXPartial Cancellation
- BDBoard
- BEProducer Reporting Structure Change
- BFBackground Investigation
- BGLicense Request
- BHBook of Business Transfer
- BIBifurcate
- BJPrint Loan Application Only
- BKGuarantee Application Only
- BLGuarantee Before Sending Application
- BMReturn Loan Application with Certification Data
- BNGuarantee After Receiving Application
- BOUse Both Date and Meter Criteria
- C1Community Service Required
- C2Convicted
- CAChange Name
- CBCut
- CCConcur
- CDCompleted Docket (Proposer Only and on Current Docket)
- CECharge
- CFConfirm
- CGConditionally Grant
- CLClosed
- CMCommence
- CNConsolidated
- COCorrect
- CPCounter Proposal
- CRProcess Immediate, Critical
- CSTransfer of Claim for Security
- CTContact Payer
- CUContinue
- CVConvert
- CXClaim Transferred
- D1Deported
- D2Dismissed
- DADivision Adjustment Only
- DBShorten Expiration Date
- DCDelivered to Another Carrier
- DDDelete and Docket (Proposer Only on Unconcurred Docket)
- DEDeny
- DFDefer
- DGDecrease
- DHExtended Expiration Date
- DIDismissed with Prejudice
- DJDismissed without Prejudice
- DKDispose
- DLDivert
- DPDelivered to Public Warehouse
- DRDirect
- DSDiscarded
- DTDiscontinue
- DXDischarged
- EAEstablish Address
- EBEstablish Additional Address
- ECEstablish Electronic Address
- EDSuppress Correspondence
- EESuppress Forms
- ENEnter
- EPEntire Patient Information
- ERExtension Request
- EVEvaluate
- EXExtend
- F1Fined
- FAFail
- FCFactor Change
- FIFile
- FOForfeit
- FRPatient Follow-Up Required
- GRGrant
- HMProcess Manually
- HRHold Until Released
- I1Found Not Guilty
- IADeactivate
- IMIncrease
- INInterim
- ISIssue
- ITInitiate
- JAJailed
- JOJoin
- JUJudgment
- KARegistration Confirmed
- LCLeft at Consignee
- LQLiquidate
- MEMerge
- MOMooting
- NANo Action Required
- NCProcess Routinely, Not Critical
- NDNo Change
- NPNot Present
- NSDo Not Send
- ODOrder
- OPOpen
- ORUse Date or Meter Criteria (whichever occurs first)
- OTOther Unlisted Action
- P1Sentenced to Probation
- PATariff Publisher Add
- PBPartial Transfer of Claim
- PCPreviously Converted
- PDTariff Publisher Delete
- PFPreliminary Final
- PIProvide Additional Information
- PJProgress Payment
- POProposed
- PPPartial Patient Information
- PRPresent
- PSProposal
- PTProposal Trace
- PUPublish Changes
- PVProvisional Payment
- R1Reopened
- R2Send Record Now
- R3Send Record at End of the Term
- R4Send Record After Degree is Posted
- R5Send Vocational Record Only
- R6Transfer
- R7Assumption
- R8Terminate
- R9Reinstate
- RARemove
- RBResecure
- RCReturned to Carrier Facility
- RDRate and Division Adjustment
- REReleased
- RFReturned to Shipper's Facility (Other Than Original Shipping Location)
- RGRefer
- RHRecall
- RIRestricted
- RJRate Adjustment
- RKRate Adjustment with a Sequence Change
- RLReschedule
- RMRemand
- RNReject Proposal with Counter Proposal to Follow
- ROReturned to Original Shipping Location
- RPRequest To Publish
- RQTariff Publisher Reissue
- RRReverse and Remand
- RSReport Status
- RTRestrain
- RUReturn
- RVRevoke
- RWRescind
- RXReplace
- S1Secure
- S2Suspended
- SASatisfy
- SBSubrogate
- SCScreen
- SDSeal
- SESettle
- SLSchedule
- SRServe
- SSSustain
- SUSuspend
- SVSever
- SZSeize
- TDTemporarily Deny
- TEOppose
- TGTemporarily Grant
- TNAnnul
- TPTemporarily Grant, in Part
- TRTrim
- TSDisallow
- TUTake Under Advisement
- VAVacate
- W1Reconcile Historical Records
- WDWithdrawn
- WIWinterize
- WQAccept
- WVWaive
Code assigned by issuer to identify reason for rejection
Codes (186)- 10Administrative Cancellation
- 11Invalid Debit Number
- 12Duplicate Sequence Number
- 13Not Valid for Price Protection
- 14Invalid part number
- 15Required application data missing
- 16Unit resale higher than authorized
- 17Negotiated price was not less than book price
- 18Ship date must not be after current date
- 19Ship date cannot be prior to price authorization issue date
- 20Ship date should not be before price authorization date (for rebills)
- 21Price authorization is a rebill type
- 23Price authorization has been deleted
- 24Price authorization used on a sales order
- 25Disposition pending vendor review.
- 26Invalid Customer Number
- 27Invalid Ship Date
- 28Duplicate Invoice Number
- 29Claim Submitted Past Exercise Period
- 30Invalid Meet Competition Cost
- 31Invalid Book Cost
- 32Input Incomplete
- 33Input Errors
- 34No Coverage
- 35Out of Network
- 36Testing not Included
- 37Request Forwarded To and Decision Response Forthcoming From an External Review Organization
- 41Authorization/Access Restrictions
- 42Unable to Respond at Current Time
- 43Invalid/Missing Provider Identification
- 44Invalid/Missing Provider Name
- 45Invalid/Missing Provider Specialty
- 46Invalid/Missing Provider Phone Number
- 47Invalid/Missing Provider State
- 48Invalid/Missing Referring Provider Identification Number
- 49Provider is Not Primary Care Physician
- 50Provider Ineligible for Inquiries
- 51Provider Not on File
- 52Service Dates Not Within Provider Plan Enrollment
- 53Inquired Benefit Inconsistent with Provider Type
- 54Inappropriate Product/Service ID Qualifier
- 55Inappropriate Product/Service ID
- 56Inappropriate Date
- 57Invalid/Missing Date(s) of Service
- 58Invalid/Missing Date-of-Birth
- 59Invalid/Missing Date-of-Death
- 60Date of Birth Follows Date(s) of Service
- 61Date of Death Precedes Date(s) of Service
- 62Date of Service Not Within Allowable Inquiry Period
- 63Date of Service in Future
- 64Invalid/Missing Patient ID
- 65Invalid/Missing Patient Name
- 66Invalid/Missing Patient Gender Code
- 67Patient Not Found
- 68Duplicate Patient ID Number
- 69Inconsistent with Patient's Age
- 70Inconsistent with Patient's Gender
- 71Patient Birth Date Does Not Match That for the Patient on the Database
- 72Invalid/Missing Subscriber/Insured ID
- 73Invalid/Missing Subscriber/Insured Name
- 74Invalid/Missing Subscriber/Insured Gender Code
- 75Subscriber/Insured Not Found
- 76Duplicate Subscriber/Insured ID Number
- 77Subscriber Found, Patient Not Found
- 78Subscriber/Insured Not in Group/Plan Identified
- 79Invalid Participant Identification
- 80No Response received - Transaction Terminated
- 81Invalid or Missing Case Number
- 82Not Medically Necessary
- 83Level of Care Not Appropriate
- 84Certification Not Required for this Service
- 85Certification Responsibility of External Review Organization
- 86Primary Care Service
- 87Exceeds Plan Maximums
- 88Non-covered Service
- 89No Prior Approval
- 90Requested Information Not Received
- 91Duplicate Request
- 92Service Inconsistent with Diagnosis
- 95Patient Not Eligible
- 96Pre-existing Condition
- 97Invalid or Missing Provider Address
- 98Experimental Service or Procedure
- 01Price Authorization Invalid
- 02Price Authorization Expired
- 03Product not on the price authorization
- 04Authorized Quantity Exceeded
- 05Zero Balance
- 06Special Cost Incorrect
- 07Catalog Cost Incorrect
- 08Invalid Ship Location
- 09No Credit Allowed
- ABAir Brakes - Inoperative, etc.
- ADAccident Damage - Derail/Sideswiped
- ARArrivals
- BAReject Due to Air Bags
- BCReject Due to No Chains
- BDReject Due to Damps
- BGReject Due to Bearings
- BLReject Due to Load Divider Bad Order
- BOLoaded Car, Unable to Load
- BPReject Due to Bridge Plate
- BRReject Due to Brake Rigging Beam, Lever
- BSReject Due to Bad Order Slides
- BVReject Due to Bad Order Valves/Piping
- BWReject Due to Bad Order Walls
- CAReject Due to Crank Arm Application
- CBReject Due to Center Bowls, Plates and Pins
- CLComplete Loading
- CMReleased as Railroad Company Material
- CNCar Not Ordered
- CPPut on Constructive Placement
- CRWrong Consignee
- CSRelease Load Through Bill Connecting Road
- CTRelease as a Cross-town Load
- CUEquipment Not Used
- DDReject Due to Doors
- DGReject Due to Draft Gear - Yoke
- DMDismantle
- DPDeparted
- DRReject Due to Dirty
- DSDefective Safety Devices
- DVReject Due to Load Dividers, Side Filters, Special Equipment
- E1Requested Record Will Not Be Sent; Cannot Identify the Record
- E2Requested Record Will Not Be Sent; Need Student or Parent Permission
- E3Requested Record Will Not Be Sent
- E4Requested Record Will Not Be Sent; Never Enrolled
- E5Requested Record Will Not Be Sent; No Degree Awarded
- E6Requested Record Will Not Be Sent; No Grades Posted
- E7Requested Record Cannot Be Sent Electronically; Record Resides in Paper Format only which Will Be Sent by Mail
- E8Requires Medical Review
- EAEmpty Equipment Available for Loading
- ERReject Due to Spotted in Error
- ETEmpty Trailer Flat Release
- FDFreight Damage Claim
- FRReject Due to Bad Floor
- GSRelease From Demurrage and Start Storage until Waybilled
- HBReject Due to Handbrake
- HHReject Due to Hand Hold, Ladder, Step, Running Boards, Platforms, etc.
- HXReject Due to Hot Journal Box
- IDReleases an Idler
- IIIndustrial Interchange
- IN
- KRReject Due to Couplers
- LKReject Due to Leaking Contents
- LSReject Due to Load Shifted
- LWLight Weigh and Restencil
- MOMove from Current Spot to Next
- OGReject Due to Outlet Gate/Valve Lo and Open Hopper
- OIReleased from Industry to be Inspected
- OROrdered for Replacement
- OVReject Due to Overloaded
- PF
- PMPreventative Maintenance
- PN
- RBReleased from Industry to Custody of Broker
- RDTo be Reloaded
- RFReject Due to Refrigeration Unit
- RHReject Due to Roof Hatches
- RKReject Due to Racks (Bi or Tri Levels)
- RLReleased
- RNBad Order Reinitialing and Numbering
- RPReleased Partially Unloaded
- RSReleased Loaded for Line Haul Shipment
- RTRun Through Equipment not Spotted
- SCReleased from Demurrage after being Scrapped
- STReleased from Shop Track
- SUReject Due to Superstructure - End, Roof and Sides
- SWLocal Waybill
- T1Cannot Identify Provider as TPO (Third Party Organization) Participant
- T2Cannot Identify Payer as TPO (Third Party Organization) Participant
- T3Cannot Identify Insured as TPO (Third Party Organization) Participant
- T4Payer Name or Identifier Missing
- T5Certification Information Missing
- T6Claim does not contain enough information for re-pricing
- TCBad Order to Transfer Lading
- TDReject Due to Tie Down Devices
- THReject Due to Trailer Hitch
- TLReject Due to Train Line, Air Hose, Anglecock
- TRReject Due to Truck, S-Frame, Bolster
- UCReject Due to Uncoupling Rod
- UFReject Due to Underframe - Including Sills
- UGBad Order for Upgrading of Car
- WAReject Due to Wheel/Axle
- WKBad Order Due to Wreck
- ZZMutually Defined
