Code identifying reason for claim submission
Type
ID
Length
Max 2 / Min 2
Codes
<> 00
Original
<> 01
Cancellation
<> 02
Corrected and Verified Original Claim
<> 03
Corrected and Verified Final Claim
<> 05
Replace
<> 07
Duplicate
<> 08
Pre-Determination
<> 09
Encounter
<> 15
Resubmission
<> 16
Proposed
<> 17
Cancel to be Reissued
<> 18
Reissue
<> 20
Final Transmission
<> 22
Information Copy
<> 27
Verify
<> 28
Late Charges
<> 29
Adjustment
<> PB
Predetermination of Dental Benefits
