CRI Claim Report Information

To specify information about the claim being reported

Position: CRI-01 · Element: 875 · Name: Maintenance Type Code · Type: Identifier (ID) · Requirement: Conditional · Min: 3 · Max: 3 · Repeat: -

Code identifying the specific type of item maintenance

P010708: If either CRI-01, CRI-07 or CRI-08 are present, then the others are required

Position: CRI-02 · Element: 1029 · Name: Claim Status Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 2 · Repeat: -

Code identifying the status of an entire claim as assigned by the payor, claim review organization or repricing organization

Position: CRI-03 · Element: 1203 · Name: Maintenance Reason Code · Type: Identifier (ID) · Requirement: Optional · Min: 2 · Max: 3 · Repeat: -

Code identifying the reason for the maintenance change

Position: CRI-04 · Element: 1073 · Name: Yes/No Condition or Response Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 1 · Repeat: -

Code indicating a Yes or No condition or response

CRI04 specifies whether there is an agreement to compensate. A "Y" indicates an agreement to compensate with liability; an "N" indicates there is no agreement to compensate.

Position: CRI-05 · Element: 594 · Name: Frequency Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 1 · Repeat: -

Code indicating frequency or type of payment

CRI05 specifies the frequency of the scheduled report.

Position: CRI-06 · Element: 1032 · Name: Claim Filing Indicator Code · Type: Identifier (ID) · Requirement: Mandatory · Min: 1 · Max: 2 · Repeat: -

Code identifying type of claim

Position: CRI-07 · Element: 1250 · Name: Date Time Period Format Qualifier · Type: Identifier (ID) · Requirement: Conditional · Min: 2 · Max: 3 · Repeat: -

Code indicating the date format, time format, or date and time format

Position: CRI-08 · Element: 1251 · Name: Date Time Period · Type: String (AN) · Requirement: Conditional · Min: 1 · Max: 35 · Repeat: -

Expression of a date, a time, or range of dates, times or dates and times

CRI08 specifies the effective date of Maintenance Type Code CRI01.

Position: CRI-09 · Element: 1129 · Name: Adjustment Reason Code Characteristic · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 2 · Repeat: -

Specifies an additional characteristic of the adjustment reason

C0901: If CRI-09 is present, then CRI-01 is required

CRI09 is the payment adjustment associated with the Maintenance Type Code.

Position: CRI-10 · Element: 9 · Name: Late Reason Code · Type: Identifier (ID) · Requirement: Optional · Min: 2 · Max: 2 · Repeat: -

Identifies the reason for tardiness

C1001: If CRI-10 is present, then CRI-01 is required

CRI10 is the reason the transaction is late.