Segment
X12 EDI Release 00404
To report compensation and or claim financial information
Elements
Specifies the situation or category to which the code applies
Codes (420)- 10Enteral or Parenteral Therapy Certification
- 11Oxygen Therapy Certification
- 12Admitting Diagnosis
- 13Principal Diagnosis
- 14Pre-Existing Physical Condition
- 15Pre-Existing Mental Condition
- 16Routine Foot Care Class Finding
- 17Systemic Condition for Routine Foot Care
- 18Co-op Advertising
- 19Commercial Advertising
- 20Specimen Kit Type Code
- 21Laboratory Test Condition Code
- 22Automobile Loss
- 23Laboratory Results Identification Code
- 24Line of Business Code
- 25United States Department of Vital Statistics E-Code
- 26Employment Status Information
- 27Income
- 28Loan Information
- 29Injury or Illness
- 30Benefit Adjustment
- 31Claimant
- 32Contractholder Branch
- 33Contractholder
- 34Secondary Claim Administrator
- 35Primary Claim Administrator
- 36Reporting Agency
- 37Process
- 38Hazardous Material
- 39Activity
- 40Accident
- 41Initial Treatment
- 42Cause of Injury
- 43Part of Body
- 44Nature of Injury
- 45Source of Injury
- 46Job
- 47Loss Prevention
- 48Managed Care
- 49Risk Management
- 50Claim Handling
- 51Event or Exposure
- 52Equipment or Materials or Chemicals
- 53Coverage
- 54Overbite
- 55Overjet
- 56Profile
- 57Crossbite
- 58Arch Asymmetry
- 59Dentition Midline
- 60Crowding
- 61Molars
- 62Cuspids
- 63Interviewee
- 64Verification of Deposit
- 65Verification of Mortgage
- 66Verification of Income or Employment or Both
- 67Verification of Rent
- 68Verification of Loan or Installment Debt or Both
- 69Anti-fungal Therapy
- 70Hospice
- 71Primary Diagnosis
- 72Secondary Diagnosis
- 73Tertiary Diagnosis
- 74Procedure Code
- 75Functional Limitations
- 76Activities Permitted
- 77Mental Status
- 78Manner Property Title Held
- 79Property Improvements
- 80Complete Appraisal
- 81Limited Appraisal
- 82Restricted Appraisal Report Limiting Conditions
- 83Route of Administration
- 84Borrower Information
- 85Contract Information
- 86Fannie Mae (Federal National Mortgage Association)
- 87Freddie Mac (Federal Home Loan Mortgage Corporation)
- 88Deductible
- 89Advertising Copy
- 90Private Remarks
- 91Compensation Notes
- 92Open House Notes
- 93Tour Notes
- 94Terms of Sale
- 95Restrictions
- 96Disclosures
- 97Exceptions
- 98Inclusions
- 99Lease Type
- 00Employee Mobility
- 01Pre-existing Conditions
- 02Diagnosis
- 03Condition
- 04Occurrence
- 05Occurrence Span
- 06Value
- 07Ambulance Certification
- 08Chiropractic Certification
- 09Durable Medical Equipment Certification
- A0Contracting District Type
- A1Mortgage Record Change
- A2Mortgage Insurance Termination
- A3Mortgage Insurance Cancellation
- A4Mortgage Servicing Transfer
- A5Appraisal
- A6State License Disciplinary Action
- A7Source of Data
- A8Endorsement
- A9Notification
- AAAll
- ABAgent's Questions
- ACAgent's Share
- ADBenefits
- AEContact or Reference Information
- AFCost Basis
- AGDriving Infractions
- AHExcess Dividend Use
- AIHome Health Aide
- AJExisting Coverage Information
- AKHospitalization
- ALActivity Limitations
- AMJuvenile Information
- ANOccupation Information
- AOPersonal Finance and Business Information
- APAppearance
- AQRating Information
- ARArrest
- ASReplaced Amount
- ATAuthority
- AUAutomated Underwriting Information
- AVAviation
- AWSurgery
- AXTravel Information
- AYAge Remark
- AZProperty Remark
- B1Audit Data
- B2Declaration Sheet Indicator
- B3Servicing Data
- B4Single Family
- B5Multifamily
- B6Payment Handling
- B7Ginnie Mae 1
- B8Ginnie Mae 2
- B9Ginnie Mae 2 Custom
- BABankruptcy
- BBBusiness Beneficiary
- BCBuilding Condition
- BDBuydown
- BEBeneficiary
- BFTax Agency Parcel Identifier
- BGHistorical Performance
- BHProduct Rules
- BICommercial Property
- BJUnimproved Land
- BKBanking
- BLNew Contract
- BMOriginal Contract
- BNAccess
- BPBankruptcy Petition
- BQAgent Sales Trend
- BRBroker's Price Opinion
- BSBankruptcy Statement of Financial Affairs
- BTBillings Trend
- BUAssets
- BVCash Flow
- BWCompetition
- BXCredit Line
- BYCreditors Arrangement
- BZCreditors Meeting
- C1Depreciation Conditions
- C2Adverse Environment Conditions
- C3Miscellaneous Adverse Conditions
- C4Site Conditions
- C5Subject Property Conditions
- C6Board of Directors
- C7Reserve
- C8Payment
- CACitizenship
- CBContinuing Education
- CCCompensation Calculation
- CDCause of Death
- CECondominium
- CFCooperative
- CGConviction
- CHDirect Sales Trend
- CIExport Trend
- CJFinancial Embarrassment
- CKIndebtedness
- CLCancellation
- CMClaim Amounts
- CNComparison
- COCounty
- CPComplications
- CQInitial Capital
- CRCurrent Ratio
- CSCommon Stock
- CTCommission Trend
- CUStockholders
- CVDamage
- CWWorking Capital
- CXCompensation Allocation
- CYDividend Use
- CZExcess Premium Use
- D1Unpaid Invoices
- D2Withdrawals
- D3Imports
- D4Placed for Collection
- DADrug Adjudication Information
- DBLiquidation Proceedings
- DCLocation
- DDDischarge Diagnosis
- DEDepartmental
- DFProfit Margin
- DGProposal
- DHReceivership
- DIDriver Identification Information
- DJProvider Characteristics and Resources
- DKSecondary Source of Injury
- DLPetitiions
- DMRegistered Charges
- DNCriminal Proceedings
- DOHistorical Criminal Proceedings
- DPDirections to Property
- DRDriving
- DVDriver Record Information
- E1Spectacle Lenses
- E2Contact Lenses
- E3Spectacle Frames
- E4Employment
- E5Examiner's Comments
- EBIntercompany Relations
- ECJudgments
- EDLiens
- EEOperating Surplus Trend
- EFParticipating Interest
- EGProtested Bills
- EHSubcontracting Details
- EISuits
- EJUniform Commercial Code (UCC) Filings
- EKDetrimental Legal Filings
- ELCustomer Details
- EMSupplier Detail
- EREmployee Relocation
- FAFinancial
- FCFamily Coverage
- FHFamily History
- FIFinancing
- FLFlood Determination
- FPFranchise Tax Payments
- FRFinancial Remarks
- FTForeign Travel
- GDDemonstrations
- GSShelf Format
- GUGuarantees
- HAFixed
- HBAdjustable
- HCRate Adjustment
- HDPayment Adjustment
- HELife of Loan
- HFPeriodic Interest Rate
- HGPrincipal and Interest
- HHHealth or Medical
- HILate Charge
- HJDefault Note Holder's Cost
- HKPrepayment
- HLLimited Payment
- HMRate Lookback
- HNPayment Lookback
- HOIndex
- HPMortgage Margin
- HQSingle Family 2-4 Units
- HRAmortization
- HSRate Conversion
- HTInterest Only
- HUPremium Audit Key Question
- HYHistory
- HZHazardous Sports
- ICIssued Capital
- IDIdentification
- IHInsurance History or Other Coverage
- IMImpairment
- INInsurance
- LALicense Revocation
- LCLocation Status
- LELevel Remarks
- LILiability Status
- LLLocal Language Description
- LRListing Remarks
- LSLife Style
- LTLegal Type
- LZLoss Trend
- MAMarital Status
- MIMiscellaneous
- MLMultiple Listing Service
- MNManagement
- MOModification
- MPMedication or Prescription
- MSMedical Social Worker
- MTMilitary Status
- NCNominal Capital
- NLNew Licensed Staff
- NSNature of Suit
- NWNot Work Related
- OAOwner Pays Notes
- OCOccupation Class
- OFOutside Financing
- OIOther Investor
- ONOperations Trend
- OPOperations
- OTOccupational Therapy
- OUOperations Outlook
- PAPerformance
- PBProfitability
- PCPaid in Capital
- PDPublic Records
- PEPenalty
- PFProfit Trend
- PGPossession Notes
- PIPhoto Instructions
- PNParking Notes
- POProfit Outlook
- PRProperty
- PSPreferred Stock
- PTPhysical Therapy
- R1Reason for Weight Loss
- R2Association of American Railroads Special Proper Shipping Name Flag
- R3Association of American Railroads Intermodal Indicator
- R4Association of American Railroads U.S. to Canada Flag
- R5Residential Status
- RCRevocation
- RERecovery
- RIReal Estate Property Information
- RLRadio License Application
- RMRemedy
- RNRelated Entities
- RPRetirement Plan Type
- RRReinstatement
- RSReason Last Seen
- RTRegistration Type
- RUResults
- RVRevenue Trend
- S1Investment Trend
- S2Royalty Trend
- S3Purchases Trend
- S4Labor Infraction
- S5Debentures
- SASource Fund
- SDStarting Details
- SESummary and Evaluation
- SIShowing Instructions
- SJSuits, Judgments & Liens
- SLSupplement Note or Line
- SNSkilled Nursing
- SPStatement Preparation
- SRSales Trend
- SSSuspension
- STSpeech Therapy
- SUSubstance Use
- SWReported Statement of Witness
- SZSize
- TBTobacco
- TETests
- TFTarget Fund
- THTherapy
- TIAction
- TMTerms
- TNTrend
- TPTenant Pays Notes
- TRTreatment
- TWTwo to Four Units
- TXTax Service
- UAProduction Capacity
- UBActual Production
- UCBranch Trend
- UDRetail Locations
- UENet Profit
- UFOrdinary Profit
- UGDeclared Profit to Local Tax Office
- UHMarket Trend
- UIPre Tax Profit
- UJNet Worth
- UKDebt to Equity
- ULEquity Return
- UMStability
- UNEfficiency
- UOOutlook
- UPUpdate
- UQCorporate Registration
- VAVoter Registration Application
- VDVoter Registration Application Disposition
- VOViolation
- WAWarning
- WBPrognosis
- WC
- WDTreatment Plan
- WEWork Restrictions
- WFWitness Statement
- WGConditions Affecting Total Employees and Hours
- WHInjury Work Related
- WIIllness Work Related
- WKControvert Reason
- WLSupervisor's Comments
- WMWillful Misconduct
- WNSupervisor's Exception
- WOClaim Related Work Assignment Changes
- WP30 Day Delay Reason
- WQEmployee Comment
- WREmployee Comment Not Provided Reason
- WSMedical Records Not Attached Reason
- WTWork Exposures and Duration
- X1Letter of Credit Overdrawn
- X2Cargo Receipt Not Signed
- X3Customs Statement Missing from Invoice
- X4Purchase Order Not on Letter of Credit (Except Masters)
- X5Reduced Draft
- X6Time Drafts
- X7Demand for Payment
- X8Early Presentation of Documents
- ZZMutually Defined
Code indicating reason for debit or credit memo or adjustment to invoice, debit or credit memo, or payment
Codes (480)- 10Pallet/Container Charge Error
- 11Returns - Damage
- 12Returns - Quality
- 13Returns - Dating
- 14Returns - Promotion
- 15Returns - Recall
- 16Non-Invoice Related Allowance/Charge
- 17Required Data Missing
- 18Not Company Bill
- 19Duplicate Billing
- 20Balance Due Declined
- 21Shipment Method of Payment Incorrect
- 22Weight Error
- 23Special Charge Not Authorized
- 24Incorrect Discount
- 25Item Not Accepted
- 26Invoice Cancelled
- 27Product Transfers Subject to Charge Back
- 28Rebated Shipments
- 29Fee Incorrect
- 30Delivery Charge Incorrect
- 31Pickup Charge Incorrect
- 32Oversize Premium Invalid
- 33Currency Exchange Incorrect
- 34Declared Value Incorrect
- 35Commodity Code Incorrect
- 36Scale Number Incorrect
- 37Dimensions Incorrect
- 38Service Incorrect
- 39Shipper/Consignee Ref. Number Missing
- 40Address Incorrect
- 41Item Not Accepted-Delay
- 42Item Not Accepted - Loss
- 43Missing Discount
- 44Required Documents Missing
- 45Stale Bill Over 180 Days Old
- 46Transportation Charge Incorrect
- 47Advanced Charge Incorrect
- 48Service Charge
- 49Processing Charge
- 50Late Charge
- 51Interest Penalty Charge
- 52Credit for Overpayment
- 53Remittance for Previous Underpayment
- 54Freight Deducted
- 55Tax Deducted
- 56Advertising Allowance Taken
- 57Volume Discount Taken
- 58Invoice billing received after final billing
- 59Item not received
- 60No open item on file
- 61No open order on file
- 62Material/Item Description Error
- 63Customer Paid Invoice Which Was Previously Disputed
- 64Sale of Property
- 65Claim Paid on Appraisal
- 66Disability Insurance or Income
- 68Death Benefit Reduction
- 69Employer Provided Pension
- 70Advanced Ship Notice Not Received
- 71Advertising Allowance
- 72Authorized Return
- 73Bill of Lading Not Received
- 74Cancel or Adjust Prior Credit/Debit Adjustment
- 75Total Order Not Received
- 76Cash Discount
- 77Competitive Allowance
- 78Competitive Price
- 79Cooperative Advertising
- 80Overpayment
- 81Credit as Agreed
- 82Defective Allowance
- 83Evaluated Receipt Settlement (ERS) Delivery Charge
- 84Deviation from Order Date
- 85Distribution Discount/Allowance
- 86Duplicate Payment
- 87Duplicate Shipment
- 88Duty Charge Variance
- 89Early Buy Allowance
- 90Early Payment Allowance
- 91Engraving Charge
- 92Merchandise Not Ordered
- 93Field Destroy
- 94Fixtures Charge
- 95Floor Stock Protection
- 96Goods to Follow
- 97Handling Charge
- 98Labor Charges
- 99Late Shipment of Goods
- 00Automated Credit Card Transaction
- 01Pricing Error
- 02Allowance/Charge Error
- 03Extension Error
- 04Item Not Accepted - Damaged
- 05Item Not Accepted - Quality
- 06Quantity Contested
- 07Incorrect Product
- 08Substitute Product
- 09Terms of Sale Error
- A1Layout/Design Charge
- A2Misshipped (Wrong Product Received)
- A3New Store Allowance
- A4Nonreceipt of Goods
- A5Overage
- A6Packing Violations
- A7Payment on Account
- A8Promotional Allowance
- A9Proof of Delivery Not Received
- AAPrepaid Benefit or Advances
- ABPartial Wage Continuation
- ACApportionment or Contribution
- ADNon-Automated Credit Card Transaction
- AEUnemployment Compensation
- AFGuarantee Fee
- AGGuaranteed Amount
- AHOrigination Fee
- ALReleased to Borrower
- AMApplied to Borrower's Account
- ANAuto No Fault
- AOReturned to Lender
- APAcceleration of Benefits
- AQReturns - Overstock
- ARAcceleration of Reimbursement of Attorney Fees
- ASReturns - Discontinued
- ATAccount Location Closed
- AUAccessory Payment
- AVAdvertising Contribution
- AWStudent Card Payment
- AXPerson No Longer Employed
- AYEmployee on Leave
- AZEmployee on Strike
- B1Proof of Shipment Not Received
- B2Rebate
- B3Recovery Allowance
- B4Refurbishing Charge
- B5Repair of Goods
- B6Repay Discount
- B7Restocking Charge
- B8Routing Violation
- B9Samples Not Received
- BACanadian Goods and Services Tax
- BBQuebec Goods and Services Tax
- BCCanadian Harmonized Goods and Services Tax
- BDBad Debt Adjustment
- BEFixture Allowance
- BFReturn Allowance
- BGBag Charge
- BHOpportunity Buy
- BIHanger Charge
- BJInsurance Charge
- BKPostage Charge
- BLNet Check Returned
- BMNet Collection Expense (Factor)
- BNBonus
- BOChange to Box Office Gross
- BPNet Chargeback of Client Risk (Factor)
- BRBenefit Rate
- BSPaid During Period
- C1Settlement of Account
- C2Special Allowance
- C3Special Finish
- C4Stock Balance
- C5Temporary Allowance
- C6Testing Charge
- C7Third Party Allowance
- C8Ticketing Error
- C9Ticketing Service
- CACancelled Promotion
- CBCollected Balance Adjustment Incorrect
- CEEmployer's Legal Expenses Paid to Date
- CKValuation As Of
- CMCovered by Credit Memo
- COAdjusted Compensation Rate
- CPEmployer Paid Benefits due
- CQChange
- CRCapitation Interest
- CSAdjustment
- CTCapitation Payment
- CUCharge for Unrequested Service
- CVCapital Passthru
- CWCertified Registered Nurse Anesthetist Passthru
- D1Transfer Between Accounts
- D2Transportation Direct Billing
- D3Unauthorized Deduction
- D4Unauthorized Product
- D5Volume Discount
- D6Recovery of Standard Allowances
- D7Cost Associated with Reworked Material
- D8Count and Recount Allowance
- D9Store Stock Price Protection
- DADaylight Overdraft Charge Reversed
- DBPension or Retirement Plan Disability Benefits
- DCCanadian Pension Plan
- DDRailroad Disability
- DEDeposited Item Price Incorrect
- DFFamily Social Security
- DGDeduction Film Rental
- DHDistrict Advance
- DISocial Security Supplemental Income
- DJJones Act (Merchant Seaman Injured on the Job)
- DKDamaged Film
- DLDeposited Item Volume Error
- DMDirect Medical Education Passthru
- DOOther Group Insurance
- DPPension or Retirement Benefits
- DRSocial Security Retirements
- DSSocial Security Disability
- DTRailroad Retirement
- DUDiscontinued Product
- DVCivil Servants Plan
- DWSubrogation
- DXRoyalty Deduction Type
- DYDistribution Issue
- E1Recoupment
- E2Covered By Debit Memo
- E3Withholding
- E4Warehouse Stock Price Protection
- E5Invoice Price Protection
- E6Goods and Services Tax 0% Rate, International Documentation Will Follow
- E7Goods and Services Tax Decreased Due to Billing Error
- E8Goods and Services Tax Increased Due to Billing Error
- E9Order Cancelled
- EEEncoding Error
- EPExpanded Promotion
- EREmployer Reimbursement
- EXExpenses
- F1Defective
- F3Social Security
- F4No-Fault
- F5Other Long-term Disability Offset
- F6Indirect Offset Excess
- F7Black Lung Disease
- F8Rehabilitation
- F9Educational Benefit
- FAAnticipation Taken
- FBForwarding Balance
- FCFund Allocation
- FILate Interest Paid
- FRFilm Rental
- FTChange to Film Rental Terms
- FUForward Buy
- G1Profit Sharing
- G2Workmen's Compensation
- G3Pension
- G4Other Disability Plan
- G5Other Income
- G6Salary Continuance
- G7Short-term Disability
- G8Permanent and Total Disability
- G9State Disability Plan
- GAFree Goods
- GBCoupon Related
- GCMarket Development Fund Deduction
- GDSamples
- GESlotting Charge
- GFInvalid
- GGUnsalable Merchandise
- GHBillback Allowance Deduction
- GJUnsalable Payments Deduction
- GKSplit Commission Deduction - Basis Amount
- GLUnresolved Customer Deduction
- GMSplit Commissions Deduction - Commission Amount
- GNGeneral Advance
- GOGraduate Medical Education Passthru
- GRGuarantee
- H1Information Forthcoming
- H2Payment Previously Sent
- H3Loan Paid in Full
- H4Bill Insured
- H5Loan Service Released
- H6Partial Payment Remitted
- H7Payment Forthcoming
- H8Bill Mortgagee
- H9Coverage Summary Needed
- HAChange to House Allowance
- HBMedical Payment
- HCIndemnity Payment
- HDExpense Payment
- HEComprehensive Payment
- HFCollision Payment
- HGBodily Injury Payment
- HIProperty Damage Payment
- HMHemophilia Clotting Factor Supplement
- IAInvoice Amount Does Not Match Account Analysis Statement
- ICInterest Charge-Rate Reduced to New York Prime Rate
- IEInterest Charge - Rate Reduced to Earnings Credit Rate
- IFInsufficient Funds
- ILInterest Charge-Rate Reduced to London Inter-bank Offer Rate (LIBOR)
- INInventory Policy
- IPIncentive Premium Payment
- IRInternal Revenue Service Withholding
- ISInterim Settlement
- J1Nonreimbursable
- J2Transportation Discrepancy Report (TDR) Submitted
- J3Promised Adjustment Not Received
- J4Deficiency Report Authorized Adjustment
- J5Duplicate Summary Billing (Same Bill Number)
- J6Duplicate Summary Billing (Different Bill Number)
- J7Duplicate Summary Billing (Second Billing)
- J8Unable to Process
- J9Noninterfund Bill
- JEJournal Entry
- K1Other Coverage Placed
- K2Invalid Policy Number
- K3Renewal Not Received
- L1Audit
- L2Discount
- L3Penalty
- L4Administrative Fees
- L5Interest Due
- L6Interest Owed
- L7Miscellaneous Deductions
- L8Miscellaneous Credits
- L9Military Distribution Adjustment
- LALoans against Future Compensations
- LELevy
- LFLawyer or Claimant Attorney Fees
- LOLedger Overdraft Charge
- LPLate Payment
- LSLump Sum
- M1Advertising - Unidentified
- M2Commissions Deductions
- M3Gift Certificates
- M4Salary Deduction
- MAMarketing Allowance
- MBPickup Allowance
- MCMiscellaneous Costs
- MDIncorrect Purchase Order Number on Bill of Lading
- MEPurchase Order Number Not on Bill of Lading
- MFMultiple Purchase Order Numbers on Invoice
- MGPurchase Order Number Incorrect on Invoice
- MHPurchase Order Number Not on Invoice
- MITransfer or Debit Balance
- MJTruckload Allowance
- MKWarehouse Allowance
- MLMaximum Allowable Levy Exceeded
- MMIncorrect Product ID on Cartons
- MNIncorrect Purchase Order Number on Carton
- MONo Product ID on Cartons
- MPNo Purchase Order Number on Carton
- MQStorage Charges
- MVMiscellaneous Event
- N1Second Injury Fund
- N2Future Credit Amount
- N3Vocational Rehabilitation
- N4Uninsured Employer
- N5Silicosis, Dust Diseases, and Logging Industry Fund
- N6Vocationally Handicapped Fund
- N7Non-designated Fund
- NACash Receipt
- NBNon-Billable
- NCNegative Charge
- NDRoyalty
- NLNew Location
- NONew Promotion
- NPNew Product
- NRNegative Repayment
- OAOrgan Acquisition Passthru
- OBOffset for Affiliated Providers
- OCOverstock Condition
- OLCourt Ordered Lien
- OPOrder Policy
- OTOther Trading-Partner Specific Reason
- P1Price Change
- P2Product Changeover
- P3Production Issue
- PAPicture Advance
- PBMaterials
- PCAmendment of Limits
- PDPaid to Date
- PEEmployment Benefits
- PFPayment First
- PGCarrier Filed Limitation
- PHCommissions
- PIPeriodic Interim Payment
- PJIntercompany Sale
- PKLodging
- PLPayment Final
- PMPrevious Month's Earnings Credit Carried Forward
- PNMeals
- POFederal Deposit Insurance Corporation (FDIC) Premium Overcharge
- PPQuebec Pension Plan
- PQOvertime
- PRPrior Film Rental Payment
- PSProduct Exclusion
- PTPayment
- PUSeverance
- PVSpecial
- PWState Limitation
- PXStore Certificates
- PYTips
- PZEquipment Rental
- R1Returned Deposited Item Price Incorrect
- R2Returned Deposited Item Volume Error
- R3Returned Deposited Item Notification Volume Error
- R4Reduced Promotion
- R5Revised Plan (Re-plan)
- R6Revised Promotion
- RARetro-activity Adjustment
- RBAgreed Freight Allowance
- RCAuthorized Air Shipment
- RDReceiving Discrepancy
- REReturn on Equity
- RFCommission Discrepancy
- RGDifference On Returns
- RHEarly Shipment of Goods
- RIExcessive Packing Materials
- RJFailure to Consolidate
- RKFreight on Returns Inbound Only
- RLFreight on Returns Outbound Only
- RMReturned Material
- RNHandling Charge for Item Not Received
- ROHandling Charge for Non Receipt of Goods
- RPHandling Charge for Late Advance Ship Notice
- RQHandling Charge for Samples Not Received
- RRHandling Charge for Unreadable Advance Ship Notice
- RSIncorrect Packing Assortment
- RTIn-store Decoration Allowance
- RUInterest
- RVLabel Placement
- RWMargin Contribution
- RXMark Down Allowance
- RYMultiple Shipment Penalty
- RZOpening Order Allowance
- SAPaper Invoice Missing
- SCService Cancelled
- SDScreening Deduction
- SEPaper Packing Slip Missing
- SFShipping and Freight Charge
- SGPickup Charge or Advanced Charges
- SHPresentation of Merchandise Not As Specified
- SIPurchaser Supplied Raw Material
- SJReturns Freight Discrepancy
- SKSalary Discrepancy
- SLStudent Loan Repayment
- SMShipped Past Purchase Order Cancellation Date
- SNShould Be Shipped Collect, But Was Shipped Prepaid
- SOShould be Shipped Prepaid, But Was Shipped Collect
- SPSales Promotion
- SRStore Contest Allowance
- SSTrade Discount
- STUnauthorized Air Shipment-Chargeback is the Difference Between Air and Ground
- SUUnauthorized Air Shipment-Partial Freight Chargeback
- SVUnauthorized Air Shipment-Full Freight Chargeback
- SWUnauthorized or Incorrect Carrier
- SXVolume Break Chargeback
- SYWeight Break Chargeback
- TATheatre Advance
- TDTotal Deductions
- TITransportation Issue
- TLThird Party Liability
- UBUncollected Balance Charge Reversed
- ULUnable to Locate Account
- VCValue Date Incorrect for Credit
- VDValue Date Incorrect for Debit
- VOVoid
- W6Safety Violations
- W8Intoxication
- W9Noncooperation: Rehabilitation, Training, Education, Medical
- WAActual Reduced Earnings
- WBRegular Wage Minus Disability Benefit
- WCSubrogation Recovery
- WEWeather-related Event
- WHPayment Partial
- WOOverpayment Recovery
- WRDeemed Reduced Earnings
- WSSpecial Fund Recovery
- WTDeductibles Recovery
- WUUnspecified Recovery
- WWOverpayment Credit
- WXCost of Living
- WYContinuous Disability Period
- WZIllegally Employed Minor
- XAAge 65 Reduction
- XBAppeal
- XCAdvance Reimbursement
- XDIndividual Payment
- XEEmployer Credit
- XFOutlier
- ZZMutually Defined
Specifies an additional characteristic of the adjustment reason
Codes (157)- 1Primary Disability - Frozen
- 2Primary Disability - Non-frozen
- 3Dependent Disability - Frozen
- 4Dependent Disability - Non-frozen
- 5Retirement - Frozen
- 6Retirement - Non-frozen
- 7Permanent
- 8Temporary
- 9Canadian
- 10Joint
- 11Deferred
- 12Eligible
- 13Applied
- 14Receiving
- 15Defense Medical Evaluation
- 16Delayed Reporting Penalty (Insured)
- 17Engineering Services
- 18Expert Test (Trial)
- 19Expert Fees and Expenses (excluding tests and testimony)
- 22Fee Schedule Savings
- 23Fatal
- 24Permanent Total
- 25Permanent Total Supplemental
- 26Permanent Partial Scheduled
- 27Permanent Partial Unscheduled
- 28Temporary Total
- 29Temporary Partial
- 30Employer Liability
- 31Permanent Partial Disfigurement
- 32Unspecified Employer Payments
- 34Funeral Expenses
- 35Penalties
- 36Interest
- 37Employer's Legal Expenses
- 38Claimant's Legal Expenses
- 39Payments to Physicians
- 40Hospital Costs
- 41Other Medical
- 42Vocational Rehabilitation Evaluation
- 43Vocational Rehabilitation Education
- 44Other Vocational Rehabilitation
- 45Total Temporary Catastrophic
- 46Unknown Payment Type
- 57Vocational Rehabilitation Maintenance
- 58Claim Value Recovery
- 60Deductible Recovery
- 61Additional Living Expense
- 62Alternative Dispute Resolution Services
- 63Anesthesiologist
- 64Annuity
- 65Attorney Expenses
- 66Attorney Fees
- 67Auto Liability Subrogation
- 69Not Eligible
- 71Catastrophic Benefits
- 72Central Index Bureau Filing Fees
- 73Chiropractor
- 74Indemnity Reserves
- 75Medical Reserves
- 76Expense Reserves
- 77Vocational Rehabilitation Reserves
- 78Indemnity Payments
- 79Medical Payments
- 80Expense Payments
- 81Vocational Rehabilitation Payments
- 82Claim Payment
- 83Claim Reserve
- 84Bodily Injury Payment
- 85Bodily Injury Reserve
- 86Property Damage Payment
- 87Property Damage Reserve
- 88Comprehensive Payment
- 89Comprehensive Reserve
- 90Collision Payment
- 91Collision Reserve
- 92Salvage
- 93Expert Witness Fees
- 94Claimant Legal Expense
- 95Claimant Medical Evaluation
- 96Commercial Photographers
- 97Mandated Medical Exam
- 98Death Benefits
- 99Defense Attorney Fees and Expenses
- A1Funeral Benefits
- A2Hearing Attendance or Representation Fees
- A3Hospital - Inpatient Charges
- A4Hospital - Outpatient Charges
- A5Hospital Bill Audit
- A6Impairment Income Benefits
- A7Independent Adjustor Expense
- A8Independent Medical Exam
- A9Legal Expenses - Miscellaneous
- AAChiropractic Expenses
- ABDental Expenses
- ACPhysical Therapy Costs
- ADPharmaceutical Costs
- AEDurable Medical Costs
- AFMedical Travel Costs
- AGEmployee Medical-Legal Costs
- AHEmployer-Claim Administrator Medical-Legal Costs
- AIAgreed upon or Directed Medical-Legal Costs
- AJUnallocated Funds
- AKFuture Credit Recovery
- B1Liability Settlement
- B2Life Pension
- B3Lump Sum Remarriage Payment
- B4Lump Sum Settlement Amount
- B5Major Case of Individual Case Reporting
- B6Medical Equipment
- B7Peer Review Board Expenses
- B8Medical Management Services
- B9Medical Records or Reports
- C1Medical Rehabilitation
- C2Medical Test (Trial)
- C3No-fault benefit or expense (Non-Workers Compensation)
- C4Nursing Care
- C5Extended Care Facility
- C6State Fund - Other
- C7Penalties Paid on Medical Benefits
- C8Penalties Paid on Indemnity Benefits
- C9Pension Indemnity Benefit
- D1
- D2Personal Property or Contents
- D3Pharmacy
- D4Photographs other than Commercial
- D5Physiotherapy
- D6PPO (Preferred Provider Organization) Fees or Expenses
- D7Product Liability Subrogation
- D8Property Adjustment
- D9Provider Bill Audit Expense
- E1Radiology
- E2Time and Expense Fees
- E3Scheduled Award
- E4Social Security
- E5State Second Injury Fund
- E6State Supplemental Fund
- E7Supplemental Permanent Total Benefits
- E9Employee Interest
- F1Testing Lab
- F2Third Party Contribution
- F3Transportation - Other
- F4Transportation - Medical Treatment
- F5Treating or Panel Physician
- F6Utilization Review - Hospital
- F7Utilization Review - Physician
- F8Unallocated Indemnity
- F9Unallocated Medical
- G2Witness Fees and Expenses - Other than Expert Witness
- G3Vocational Rehabilitation Training
- G4Appraisal Fees
- G5Autopsy Fees
- G6Surveillance Special Investigation Fees and Expenses
- G7Temporary Income Benefits
- G8
- G9Federal Second Injury Fund
- H2Federal Supplemental Fund
- H3Flat Rate
Code identifying the specific type of item maintenance
Codes (123)- 100Sale of Mortgage Change
- 101Servicer Change
- 102Mortgagor Change
- 104Prepayment Termination
- 105Non-conveyance Termination
- 106Voluntary Action Termination
- 107Loan Refinanced Termination
- 108Transfer Due to Interest and Servicing Sold
- 109Retain Servicing
- 110Transfer Servicing
- 111Assign Servicing
- 112Servicer Loan Number Change
- 113Merger
- 114Acquisition
- 115Receivership
- 116Loan Maturity Maintenance
- 117Binder
- 118New Policy
- 119Renewal Policy
- 123Canceled by Administrator
- 124Canceled by Insured
- 125Re-Write
- 126Non-renewal
- 127Termination of All Endorsements
- 128Termination of Lessor Interest
- 129Termination of Additional Insured Interest
- 130Termination of Lienholder or Loss Payee
- 131Addition of Lessor Endorsement
- 132Addition of Lienholder Endorsement
- 133Addition of Additional Insured Endorsement
- 134Change of Lessor Endorsement
- 135Change of Lienholder Endorsement
- 136Change of Additional Insured Endorsement
- 137Acquired Unallocated
- 138Acquired Payment
- 139Investigation Pending
- 140Concurrent Benefit
- 141Abbreviated First Report on an Acquired Claim
- 142Employer Paid
- 143Employer Reinstatement
- 144Suspension Directed by Agency
- 145Occupational Safety and Health Administration Injury and Illness Log (OSHA-300)
- 146Occupational Injury Survey
- 147Bureau of Labor and Statistics Survey
- 148First Payment on an Acquired Claim
- 149First Report on an Acquired Claim
- 150Impairment Report
- 151Return to Work Report
- 152Office of Workers Compensation Program Injury Claim Report (OWCP CA-1)
- 153Office of Workers Compensation Program Illness Claim Report (OWCP CA-2)
- 154Occupational Safety and Health Administration Injury and Illness Record (OSHA-301)
- 155First Aid Injury Only
- 001Change
- 002Delete
- 003Add Full Item Detail
- 004Withdraw Item (Temporary)
- 005Restore Item
- 006Membership Type
- 007Purchase Eligibility
- 008Verified
- 009Not Verified
- 010Periodic Report
- 011All Items Refresh
- 012Medical Noncompliance
- 013Administrative Noncompliance
- 014Suspended Pending Settlement Approval
- 015Suspended Pending Appeal or Judicial Review
- 016Injury Report Creation
- 017Illness Report Creation
- 018Transfer of Beneficial Rights
- 019Record Security Instrument
- 020Assignment
- 021Addition
- 022Change in Status
- 023Change in Rate Factors
- 024Cancellation or Termination
- 025Reinstatement
- 026Correction
- 028Policy Adjustment
- 029Inquiry
- 030Audit or Compare
- 031Medical Examination Authorization
- 032Employee Information Not Applicable
- 033Release of Interim Funding Interest
- 050Original
- 051Denial
- 052Initial Payment
- 053Change in Benefit Amount
- 054Change in Benefit Type
- 055Reinstatement of Benefit
- 056Reduced Earnings
- 057Final
- 059Suspension Medically Determined or Qualified to Return to Work
- 060Non-compliance of Medical Requirements
- 061Non-compliance of Administrative Requirements
- 062Compensable Death
- 063Incarceration
- 064Claimant's Whereabouts Unknown
- 065Volunteer
- 066Status Request
- 067Benefits Exhausted
- 068Jurisdictional Change
- 069Payment Notification
- 070Status Request Response
- 071Re-issue Identification Card(s)
- 072Suspension Due to Claimant Death
- 073Partial Denial
- 074Partial Suspension, Returned to Work, or Medically Determined or Qualified to Return to Work
- 075Partial Suspension, Medical Non-compliance
- 076Partial Suspension, Administrative Non-compliance
- 077Partial Suspension, Claimant Death
- 078Partial Suspension, Incarceration
- 079Partial Suspension, Claimant's whereabouts Unknown
- 080Partial Suspension, Benefits Exhausted
- 081Partial Suspension, Jurisdiction Change
- 082Partially Suspended, Benefits Pending Settlement Approval
- 083Partially Suspended, Pending Appeal or Judicial Review
- 084Lump Sum Benefit Payment
- 085Suspension Denial
- CEPChange Excluding Price
- PRIPrice Change Only
- TBVTo Be Verified
- ZZZMutually Defined
Code indicating frequency or type of activities or actions being reported
Codes (23)- 0Annualized; 12-month equivalent
- 1Weekly
- 2Biweekly
- 3Semimonthly
- 4Monthly
- 5Other
- 6Daily
- 7Annual
- 8Two Calendar Months
- 9Lump-Sum Separation Allowance
- AQuarter-to-Date
- BYear-to-Date
- CSingle
- DPolicy Period
- EClaim Period
- FUnit Report Identifier
- GMonth-to-Date
- HHourly
- JCurrent Period
- QQuarterly
- SSemiannual
- UUnknown
- ZMutually Defined
Identifies the reason for tardiness
Codes (23)- C1Coverage Lack of Information
- D1Dispute Concerning Coverage
- D2Dispute Concerning Compensability in Whole
- D3Dispute Concerning Compensability in Part
- D4Dispute Concerning Disability in Whole
- D5Dispute Concerning Disability in Part
- D6Dispute Concerning Impairment
- E1Wrongful Determination of No Coverage
- E2Error(s) from Employer
- E3Error(s) from Employee
- E4Error(s) from State
- E5Error(s) from Health Care Provider
- E6Error(s) from Other Claim Administrator, Independent Adjuster or Third Party Administrator
- L1Late No Excuse
- L2Late Notification, Employer
- L3Late Notification, Employee
- L4Late Notification, State
- L5Late Notification, Health Care Provider
- L6Late Notification, Assigned Risk
- L7Late Investigation
- L8Technical Processing Delay or Computer Failure
- L9Manual Processing Delay
- LAIntermittent Lost Time Prior to First Payment
