F12 Basic Claim Information - Automotive

To provide information for automotive claims

Position: F12-01 · Element: 127 · Name: Reference Number · Type: String (AN) · Requirement: Mandatory · Min: 1 · Max: 30 · Repeat: -

Reference number or identification number as defined for a particular Transaction Set, or as specified by the Reference Number Qualifier. Also see Reference Number Qualifier, (128).

Position: F12-02 · Element: 127 · Name: Reference Number · Type: String (AN) · Requirement: Mandatory · Min: 1 · Max: 30 · Repeat: -

Reference number or identification number as defined for a particular Transaction Set, or as specified by the Reference Number Qualifier. Also see Reference Number Qualifier, (128).

Position: F12-03 · Element: 373 · Name: Date · Type: Date (DT) · Requirement: Mandatory · Min: 6 · Max: 6 · Repeat: -

Date (YYMMDD). Also see: Date Qualifier (432).

Position: F12-04 · Element: 475 · Name: Credit Memo/Debit Memo Number · Type: String (AN) · Requirement: Mandatory · Min: 1 · Max: 16 · Repeat: -

Document number assigned by the issuer for additional charges or credit amounts.

Position: F12-05 · Element: 476 · Name: Credit Memo/Debit Memo Date · Type: Date (DT) · Requirement: Mandatory · Min: 6 · Max: 6 · Repeat: -

Date on which credit memo or debit memo was issued or made effective.

Position: F12-06 · Element: 543 · Name: Labor Rate · Type: N2 · Requirement: Mandatory · Min: 3 · Max: 4 · Repeat: -

The labor/time guide rate used by the division to reimburse the dealer for repair work.

Position: F12-07 · Element: 543 · Name: Labor Rate · Type: N2 · Requirement: Mandatory · Min: 3 · Max: 4 · Repeat: -

The labor/time guide rate used by the division to reimburse the dealer for repair work.