F12 Basic Claim Information - Automotive
Opt
AtMax 1
To provide information for automotive claims
Elements
| Position | Element | Name | Type | Min/Max | Repeat | |
|---|---|---|---|---|---|---|
| 1 | 127 | Reference Identification | Mandatory | Alphanumeric | 1/50 | AtMax 1 |
| 2 | 127 | Reference Identification | Mandatory | Alphanumeric | 1/50 | AtMax 1 |
| 3 | 373 | Date | Mandatory | Date | 8/8 | AtMax 1 |
| 4 | 475 | Credit/Debit Adjustment Number | Mandatory | Alphanumeric | 1/22 | AtMax 1 |
| 5 | 373 | Date | Mandatory | Date | 8/8 | AtMax 1 |
| 6 | 543 | Labor Rate | Mandatory | Number | 3/6 | AtMax 1 |
| 7 | 543 | Labor Rate | Mandatory | Number | 3/6 | AtMax 1 |
| 8 | 927 | Damage Code Qualifier | Opt | ID | 1/1 | AtMax 1 |
Element Details
ID127
NameReference Identification
LengthMin 1 / Max 50
Position1
RequirementMandatory