F12 Basic Claim Information - Automotive

To provide information for automotive claims

Position: F12-01 · Element: 127 · Name: Reference Identification · Type: String (AN) · Requirement: Mandatory · Min: 1 · Max: 80 · Repeat: 1

Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier

F1201 is used for dealer's repair order number.

Position: F12-02 · Element: 127 · Name: Reference Identification · Type: String (AN) · Requirement: Mandatory · Min: 1 · Max: 80 · Repeat: 1

Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier

F1202 is used for dealer's document number.

Position: F12-03 · Element: 373 · Name: Date · Type: Date (DT) · Requirement: Mandatory · Min: 8 · Max: 8 · Repeat: 1

Date expressed as CCYYMMDD where CC represents the first two digits of the calendar year

F1203 is used for repair order date.

Position: F12-04 · Element: 475 · Name: Credit/Debit Adjustment Number · Type: String (AN) · Requirement: Mandatory · Min: 1 · Max: 22 · Repeat: 1

Number assigned by issuer of a credit or debit memo

F1204 and F1205 will be used if sublet services are reported.

Position: F12-05 · Element: 373 · Name: Date · Type: Date (DT) · Requirement: Mandatory · Min: 8 · Max: 8 · Repeat: 1

Date expressed as CCYYMMDD where CC represents the first two digits of the calendar year

F1205 contains the debit/credit memo date.

Position: F12-06 · Element: 543 · Name: Labor Rate · Type: N2 · Requirement: Mandatory · Min: 3 · Max: 6 · Repeat: 1

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

F1206 is used for body repair rate.

Position: F12-07 · Element: 543 · Name: Labor Rate · Type: N2 · Requirement: Mandatory · Min: 3 · Max: 6 · Repeat: 1

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

F1207 is used for chassis repair rate.

Position: F12-08 · Element: 927 · Name: Damage Code Qualifier · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 1 · Repeat: 1

Code identifying the party maintaining damage area, damage type and damage severity code lists