EDI Dictionary
Schedule demo
X12 Release 4010
X12 Release
4010
4020
4030
4040
4050
4060
5010
5020
5030
5040
5050
6010
6020
6030
6040
6050
7010
7020
7030
7040
7050
7060
8010
Transaction Sets
Segments
Elements
EDI-Dictionary
4010
CSI
CSI
Claim Status Information
Batch
To indicate the status of a claim for mortgage insurance benefits
Elements
Position
Element
Name
Type
Min/Max
Repeat
1
1383
Claim Submission Reason Code
Mandatory
ID
2/2
1
2
374
Date/Time Qualifier
Mandatory
ID
3/3
1
3
1250
Date Time Period Format Qualifier
Mandatory
ID
2/3
1
4
1251
Date Time Period
Mandatory
Alphanumeric
1/35
1
Element Details
ID
1383
Name
Claim Submission Reason Code
Length
Min 2 / Max 2
Position
1
Requirement
Mandatory
Codes
<>
15
Resubmission
<>
07
Duplicate
<>
28
Late Charges
<>
22
Information Copy
<>
00
Original
<>
29
Adjustment
<>
17
Cancel to be Reissued
<>
01
Cancellation
<>
18
Reissue
<>
16
Proposed
<>
20
Final Transmission
<>
PB
Predetermination of Dental Benefits
<>
02
Corrected and Verified Original Claim
<>
27
Verify
<>
05
Replace
<>
08
Pre-Determination
<>
03
Corrected and Verified Final Claim
<>
09
Encounter