Date expressed as CCYYMMDD where CC represents the first two digits of the calendar year

F1101 contains the date of the claim.

Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier

Reference numbers in this segment are F1102 claimant's claim number, and F1103 carrier's claim number.

Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier

Monetary amount

F1104 is the claim amount specified in the currency of the country where the carrier to whom the claim is made is located.

Monetary amount

F1105 is required when F1106 indicates a payment, which is shown with codes "PF" or "PP".

Code identifying the status of a business transaction, such as a claim, policy, real estate, or securities transaction

Date expressed as CCYYMMDD where CC represents the first two digits of the calendar year

F1107 contains the date of status report.

Code indicating the reason for declination or amendment

F1108 is required when F1106 indicates that the claim was declined or amended.

Code specifying the Standard ISO code for country in whose currency the charges are specified

F1109 is the currency for which the claim amount is specified.

Code identifying the Reference Identification