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Segment
in
X12 Release 003030

PCS Product Claim Status

To convey the status of a product service claim or claims or to supply adjustment reason codes and amounts as needed for an entire claim or for a particular item within the claim
Sequence
Element
Name
Type
Requirement
Min
Max
Repeat
01
1029
Claim Status Code
Identifier (ID)
Conditional
1
2
-
Code identifying the status of an entire claim as assigned by the payor.
R0104
PCS01 will be used principally when the entire claim has been approved and no more detail is required or when there is a question about the claim that has to be decided and the claim response is to inform the claimant that the claim is pending and has not been forgotten.
Codes (23)
02
Agency Qualifier Code
Identifier (ID)
Conditional
2
2
-
Code identifying the agency assigning the code values.
C0204
PCS02 identifies the source of the code.
Codes (72)
03
Source Subqualifier
String (AN)
Optional
1
15
-
A reference that indicates the table or text maintained by the Source Qualifier.
C0302
PCS03 specifies a particular table of codes maintained by the agency identified in PCS02.
04
Claim Response Reason Code
Identifier (ID)
Conditional
1
3
-
Code identifying the detailed reason for the response
PCS04 identifies the status of the claim or an individual portion of the claim and the reason for any change in the claimed amount.
Codes (26)
05
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
PCS05 is the value to be paid after the application of any claim adjustment.
06
Follow-up Action Code
Identifier (ID)
Optional
1
1
-
Code identifying follow-up actions allowed.
PCS06 provides instructions to the claim submitter as to the next action to be taken when the claim was not approved as submitted.
Codes (5)
07
Agency Qualifier Code
Identifier (ID)
Conditional
2
2
-
Code identifying the agency assigning the code values.
C0709
Codes (72)
08
Source Subqualifier
String (AN)
Optional
1
15
-
A reference that indicates the table or text maintained by the Source Qualifier.
C0807
PCS08 is the source of the code in PCS09. It is a particular table of codes maintained by the organization specified in PCS07 for specifying PCS09.
09
Disposition Code
Identifier (ID)
Conditional
3
3
-
Code specifying the disposition of removed part, subassembly, or assembly
PCS09 is the disposition of the part of subassembly.
Codes (9)
10
Description
String (AN)
Optional
1
80
-
A free-form description to clarify the related data elements and their content.
PCS10 describes why a claim amount was changed when such information cannot be conveyed with a code value.
11
Authorization Identification
String (AN)
Optional
1
4
-
Identifier representing authorization of an unusual repair or some attendant condition.
PCS11 can apply to an authorization before a repair action took place.
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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.