CRI Claim Report Information

To specify information about the claim being reported

Position
Element
Name
Type
Requirement
Min
Max
Repeat
CRI-01
Maintenance Type Code
Identifier (ID)
Conditional
3
3
-
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
CRI-02
Claim Status Code
Identifier (ID)
Optional
1
2
-
Code identifying the status of an entire claim as assigned by the payor, claim review organization or repricing organization
CRI-03
Maintenance Reason Code
Identifier (ID)
Optional
2
3
-
Code identifying the reason for the maintenance change
CRI-04
Yes/No Condition or Response Code
Identifier (ID)
Optional
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.
CRI-05
Frequency Code
Identifier (ID)
Optional
1
1
-
Code indicating frequency or type of payment
CRI05 specifies the frequency of the scheduled report.
CRI-06
Claim Filing Indicator Code
Identifier (ID)
Mandatory
1
2
-
Code identifying type of claim
CRI-07
Date Time Period Format Qualifier
Identifier (ID)
Conditional
2
3
-
Code indicating the date format, time format, or date and time format
CRI-08
Date Time Period
String (AN)
Conditional
1
35
-
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.
CRI-09
Adjustment Reason Code Characteristic
Identifier (ID)
Optional
1
2
-
Specifies 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.
CRI-10
Late Reason Code
Identifier (ID)
Optional
2
2
-
Identifies the reason for tardiness
C1001: If CRI-10 is present, then CRI-01 is required
CRI10 is the reason the transaction is late.

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