Segment
X12 EDI Release 00504
To specify the characteristics of an adjustment
Elements
Code indicating reason for debit or credit memo or adjustment to invoice, debit or credit memo, or payment
Codes (612)- 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
- AIHanger - Non Store Approved Hanger
- AJHanger - Missing or Failure to Supply Hanger
- AKHanger - Wrong Color
- 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)
- BQHanger - Wrong Size
- BRBenefit Rate
- BSPaid During Period
- BTHanger - Quality Issue
- BUHanger - Size Tab or Clip Missing
- BVHanger - Size Tab or Clip Did Not Match Garment Size
- BWHanger - Product Hung Incorrectly
- BXExcess Packaging - Clips
- BYExcess Packaging - Tissue
- BZExcess Packaging - Foam
- 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
- CCExcess Packaging – Cardboard Layer
- CDExcess Packaging - Pins
- CEEmployer's Legal Expenses Paid to Date
- CFExcess Packaging - String
- CGExcess Packaging - Tiebacks
- CHProduct Quality - Excess Wrinkling
- CISize Indicator Strips - Missing
- CJSize Indicator Strips - Improper Placement
- CKValuation As Of
- CLSize Indicator Strips - Incorrect Size Information
- CMCovered by Credit Memo
- CNItem Tickets - Incorrect Information Zone 1 - Description
- COAdjusted Compensation Rate
- CPEmployer Paid Benefits due
- CQChange
- CRCapitation Interest
- CSAdjustment
- CTCapitation Payment
- CUCharge for Unrequested Service
- CVCapital Passthru
- CWCertified Registered Nurse Anesthetist Passthru
- CXItem Tickets - Incorrect Information Zone 2 - Vendor Information
- CYItem Tickets - Incorrect Information Zone 3 - Symbol
- CZItem Tickets - Incorrect Information Zone 4 - Consumer Information
- 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
- DNItem Tickets - Incorrect Information Zone 5 - Size or Dimension
- DOOther Group Insurance
- DPPension or Retirement Benefits
- DQItem Tickets - Incorrect Information Zone 6 - Retail Price
- DRSocial Security Retirements
- DSSocial Security Disability
- DTRailroad Retirement
- DUDiscontinued Product
- DVCivil Servants Plan
- DWSubrogation
- DXRoyalty Deduction Type
- DYDistribution Issue
- DZItem Tickets - Incorrect Information Zone 7 - Manufacturer's Suggested Price
- 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
- EAItem Tickets - Missing Information Zone 1 – Description
- EBItem Tickets - Missing Information Zone 2 - Vendor Information
- ECItem Tickets - Missing Information Zone 3 - Symbol
- EDItem Tickets - Missing Information Zone 4 - Consumer Information
- EEEncoding Error
- EFItem Tickets - Missing Information Zone 5 - Size or Dimension
- EGItem Tickets - Missing Information Zone 6 - Retail Price
- EHItem Tickets - Missing Information Zone 7 - Manufacturer's Suggested Price
- EIItem Tickets - Incorrect or Missing Multi-Piece Ticket
- EJItem Tickets - Information Not Readable
- EKItem Tickets - Bar Code Degradation
- ELItem Tickets - Non Perforated
- EMItem Tickets - Missing Ticket
- ENItem Tickets - Tickets in Carton - Not Attached
- EOItem Tickets - Improper Placement
- EPExpanded Promotion
- EQItem Tickets - Item Missing from Catalog at Time of Receipt
- EREmployer Reimbursement
- ESItem Tickets - Color-Coding for Size Missing or Incorrect
- ETItem Tickets - Item Ticket Affixed Improperly
- EUShip Notice - Carton Content does not Match Ship Notice
- EVShip Notice - Carton Count does not Match Ship Notice
- EWShip Notice - Serial Shipping Container Code does not Match Ship Notice
- EXExpenses
- EYShip Notice - Missing Bill of Lading Information
- EZShip Notice - Duplicate Ship Notice
- F1Defective
- F2Ship Notice - Received Late
- F3Social Security
- F4No-Fault
- F5Other Long-term Disability Offset
- F6Indirect Offset Excess
- F7Black Lung Disease
- F8Rehabilitation
- F9Educational Benefit
- FAAnticipation Taken
- FBForwarding Balance
- FCFund Allocation
- FDPurchase Order - Size Not Ordered
- FEPurchase Order - Color Not Ordered
- FFPurchase Order - Store Did Not Order
- FGPurchase Order - Item Overage
- FHPromotion Violation
- FILate Interest Paid
- FJDoes Not Accept Electronic Funds Transfer
- FKLogistics Label - Problem with Shipped From Address
- FLLogistics Label - Problem with Ship To Address
- FMLogistics Label - Problem with Postal Barcode Code
- FNLogistics Label - Problem with Carrier Information
- FOLogistics Label - Problem with Mark For Information
- FPLogistics Label - Problem with Serial Shipping Container Code
- FQLogistics Label - Problem with Barcode
- FRFilm Rental
- FSLogistics Label - Problem with Purchase Order Number
- FTChange to Film Rental Terms
- FUForward Buy
- FVLogistics Label - Problem with Mark For Barcode
- FWLogistics Label - Problem with Product Group Description
- FXLogistics Label - Problem with Carton Count
- FYLogistics Label - Incorrect Label Format
- FZLogistics Label - Incorrect Font or Print Size
- 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
- GILogistics Label - Crushed Box, Label Not Usable
- GJUnsalable Payments Deduction
- GKSplit Commission Deduction - Basis Amount
- GLUnresolved Customer Deduction
- GMSplit Commissions Deduction - Commission Amount
- GNGeneral Advance
- GOGraduate Medical Education Passthru
- GPLogistics Label - Label Does Not Scan
- GQLogistics Label - Not Human Readable
- GRGuarantee
- GSPacking - Ratio Incorrect for Pre-pack Shipment
- GTPacking - Mixed Items in Carton
- GUPacking - Crushed Box
- GVPacking - Missing or Incorrect Pallets
- GWPacking - Load Not Sorted Correctly
- GXPacking - Problem with Pack List
- GYPacking - Multiple Purchase Orders Shipped in Carton
- GZPacking - Problem with Bill of Lading Number or Format
- 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
- HHPacking - Carton Not Sealed Correctly
- HIProperty Damage Payment
- HJPolybags - Missing or Incorrect Type
- HKPolybags - Not Sealed or Incorrectly Sealed
- HLTransportation - Carrier Missed Delivery Appointment
- HMHemophilia Clotting Factor Supplement
- HNTransportation - Carrier Detained
- HOTransportation - No Shipment Approval Number
- HPTransportation - Delivery to Wrong Location
- HQTransportation - Excessive Shipments or Multiple Shipments on Consecutive Days
- 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
- K4Return Merchandise Charge
- K5Refused Merchandise Charge
- K6Unauthorized Freight Invoice
- K7Unauthorized Freight on Merchandise Invoice
- K8Freight Inbound Return Merchandise
- K9Freight Outbound Return Merchandise
- KAFull Monetary Difference Between Air and Surface Charges Per Corporate Agreement
- KBFull Monetary Difference Between Air and Surface Charges Per Purchase Order
- KCPaper Bill of Lading Missing Department Number
- KDPaper Bill of Lading Missing Purchase Order Number
- KEPaper Bill of Lading Non Standard VICS Format
- KFPaper Bill of Lading Counter/Loader Not Indicated
- KGPartial Monetary Difference Between Air and Surface Charges Per Corporate Agreement
- KHPartial Monetary Difference Between Air and Surface Chares Per Purchase Order
- KIFreight Allowance Per Corporate Agreement
- KJFreight Allowance Per Purchase Order
- KKPrepaid Advance Freight for Consolidator Shipments
- KLRedelivery Charge
- KMCharge for Second Delivery on Damaged Furniture
- KNSurface Freight Allowance Per Corporate Agreement
- KOSurface Freight Allowance Per Purchase Order
- 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
- M5Late 204 Motor Carrier Load Tender Transmission
- M6Missing 204 Motor Carrier Load Tender Transmission
- M7Late 214 Transportation Carrier Shipment Status Message Transmission
- M8Missing 214 Transportation Carrier Shipment Status Message Transmission
- M9Freight on Backorder
- 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
- MRManufacturer to Retail Bill-Back Allowance
- 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
- O1Bill of Lading Does Not Match 856 Advance Ship Notice (ASN)
- O2Incorrect Carton/Weight on Bill of Lading
- O3Charge for Combined Divisions on One Bill of Lading
- O4Charge for Consolidation Zone Freight Allowance Per Corporate Agreement
- O5Charge for Consolidation Zone Freight Allowance Per Purchase Order
- O6Charge for Exceeding Maximum Shipments Per Agreement
- O7Charge to Expedite Distribution Centre (DC) to Store
- O8Charge for Failure to Master Pack
- O9Inaccurate Cube Information
- 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
- S1Incorrect Pickup Address
- S2Charge for LTL Shipped on Consecutive Days
- S3Not Shipped on Date Authorized
- S4Shipped on Pallets
- S5Small Package Level Detail Insufficient
- S6Sort and Segregate Handling Charge
- S7Sort and Segregation Allowance Per Corporate Agreement
- S8Sort and Segregation Allowance Per Purchase Order
- S9Wrong Ship Point Per Purchase Order
- 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 (159)- 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
- 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
- G9Federal Second Injury Fund
- H2Federal Supplemental Fund
- H3Flat Rate
- H4Employer Paid Temporary Total Disability
- H5Employer Paid Temporary Partial Disability
- H6Court Reporter Fees
- H7Private Investigator Fees
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 (24)- 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
- LBAwaiting Wage Amount Verification
