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CRI Claim Report Information

To specify information about the claim being reported

Sequence
Element
Name
Type
Requirement
Min
Max
Repeat
01
875
Maintenance Type Code
Identifier (ID)
Conditional
3
3
1
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
Codes (128)
02
Claim Status Code
Identifier (ID)
Optional
1
2
1
Code identifying the status of an entire claim as assigned by the payor, claim review organization or repricing organization
Codes (46)
03
Maintenance Reason Code
Identifier (ID)
Optional
2
3
1
Code identifying the reason for the maintenance change
Codes (118)
04
Yes/No Condition or Response Code
Identifier (ID)
Optional
1
1
1
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.
Codes (9)
05
Frequency Code
Identifier (ID)
Optional
1
1
1
Code indicating frequency or type of activities or actions being reported
CRI05 specifies the frequency of the scheduled report.
Codes (23)
06
Claim Filing Indicator Code
Identifier (ID)
Mandatory
1
2
1
Code identifying type of claim
Codes (52)
07
Date Time Period Format Qualifier
Identifier (ID)
Conditional
2
3
1
Code indicating the date format, time format, or date and time format
Codes (42)
08
Date Time Period
String (AN)
Conditional
1
35
1
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.
09
Adjustment Reason Code Characteristic
Identifier (ID)
Optional
1
2
1
Code specifying 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.
Codes (159)
10
Late Reason Code
Identifier (ID)
Optional
2
2
1
Code identifying the reason for tardiness
C1001: If CRI-10 is present, then CRI-01 is required
CRI10 is the reason the transaction is late.
Codes (24)
11
Condition Indicator Code
Identifier (ID)
Optional
2
3
1
Code indicating a condition
CRI11 indicates Loss Type of workers' compensation claim.
Codes (1454)

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Stedi is a registered trademark of Stedi, Inc. Stedi's EDI Reference and Mapping Guides are provided for marketing purposes and are free of charge. All names, logos, and brands of third parties listed on our site are trademarks of their respective owners (including “X12”, which is a trademark of X12 Incorporated). Stedi, Inc. and its products and services are not endorsed by, sponsored by, or affiliated with these third parties. Our use of these names, logos, and brands is for identification purposes only, and does not imply any such endorsement, sponsorship, or affiliation.