EDI Dictionary
Schedule demo
EDI Dictionary
Transaction Sets
Segments
Elements
X12 Release 5010
X12 Release
4010
4010
4030
4050
5010
5030
5050
6020
6040
7010
7030
7050
8010
4020
4040
4060
5020
5040
6010
6030
6050
7020
7040
7060
Schedule demo
X12 Release 5010
X12 Release
4010
4010
4030
4050
5010
5030
5050
6020
6040
7010
7030
7050
8010
4020
4040
4060
5020
5040
6010
6030
6050
7020
7040
7060
Transaction Sets
Segments
Elements
EDI-Dictionary
5010
260 Application For Mortgage Insurance Benefits
CSI-100
CSI
Claim Status Information
Mandatory
AtMax 1
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
AtMax 1
2
374
Date/Time Qualifier
Mandatory
ID
3/3
AtMax 1
3
1250
Date Time Period Format Qualifier
Mandatory
ID
2/3
AtMax 1
4
1251
Date Time Period
Mandatory
Alphanumeric
1/35
AtMax 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