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R3QuickCodeReferenceList-VA _updated 7-09-08_

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					                                                   Claims R3 Quick Code Reference List - Virginia
                                               MAINTENANCE TYPE CODE (MTC's) (DN0002)                                                         OTHER BENEFIT TYPE COD
                                                          FIRST REPORT:                                                                340    Total Claimant's Legal Expens
  00    Original                                              AQ Acquired Claim                                                        350    Total Payments to Physicians
  01    Cancel                                                UR Upon Request                                                          360    Total Hospital Costs
  02    Change                                                                                                                         370    Total Other Medical
  04    Denial                                                                                                                         430    Total Unallocated Prior Indem
  AU    Acquired/Unallocated                                                                                                           440    Total Unallocated Prior Medic
                                                         SUBSEQUENT REPORT:                                                            450    Total Pharmaceutical Costs
  04    Denial                                                     Suspended Pending Appeal                                            455    Total Dental Expenses
                                                                SJ
  AP    Acquired/Payment                                           or Judicial Review                                                  460    Total Physical Therapy Costs
  EP    Employer Paid                                          UR Upon Request                                                         465    Total Chiropractic Expenses
  ER    Employer Reinstatement                                 QT Quarterly
  IP    Initial Payment
        Partial Suspension, RTW or Med
   P1
        Determined/Qualified to RTW
        Partial Suspension,
   P2
        Medical Non-Compliance
        Partial Suspension,
   P3
        Administrative Non-Compliance
   P5   Partial Suspension, Incarceration
        Partially Suspended Pending
   PJ
        Appeal or Judicial Review
  PY    Payment Report
  RB    Reinstatement of Benefit
        Suspension, RTW or Medically
   S1
        Determined/Qualified to RTW
   S2   Suspension, Medical Non-Compliance
        Suspension, Administrative
   S3
        Non-Compliance                                                                                                                           BENEFIT ADJUSTMENT
   S4   Suspension, Claimant Death                                                                                                      B     Subrogation
   S5   Suspension, Incarceration                                                                                                       1     Cost of Living Adjustment
        Suspension, Claimant's
   S6
        Whereabouts Unknown
  S7    Suspension, Benefits Exhausted
  S8    Suspension, Jurisdiction Change
  SD    Suspension, Directed By Jurisdiction

                                                     BENEFIT TYPE CODE (DN0085)
 REGULAR BENEFIT TYPES:                                        LUMP SUM PAYMENTS/SETTLEMENTS:
 010 Fatal                                                     524 Employer Paid Lump Sum Pmt/Settlement
 020 Permanent Total                                           530 Perm Partial Sch Lump Sum Pmt/Settlement
 030 Permanent Partial/Scheduled                               550 Temporary Total Lump Sum Pmt/Settlement
 050 Temporary Total                                           570 Temporary Partial Lump Sum Pmt/Settlement
 070 Temporary Partial                                         590 Perm Partl Disfigure Lump Sum Pmt/Settlement
 090 Permanent Partial Disfigurement
     Employer Paid Permenent Partial
 230
     Scheduled
 240 Employer Paid (EP) Unspecified
 250 EP Temporary Total
 270 EP Temporary Partial
 500 Unspecified Lump Sum Pmt/Settlement                                                                                                             BENEFIT CREDIT CO
 501 Medical Lump Sum Pmt/Settlement
 510 Fatal Lump Sum Pmt/Settlement
     Permanent Total Lump Sum Pmt/
 520
     Settlement

                                                                                                                                                BENEFIT REDISTRIBUTIO
                     CLAIM TYPE CODE (DN0074)                                        INSURED TYPE CODE (DN0184)
   M    Medical Only                                                    I    Insured
   I    Indemnity                                                       S    Self-Insured
   N    Notification Only                                               U    Uninsured                                                             INITIAL TREATMENT C
   B    Became Medical Only
   L    Became Lost Time                                                              INSURER TYPE CODE (DN0185)
                                                                        I    Insurer
                                                                        S    Self-Insurer
                TYPE OF LOSS CODE (DN0290)                              G    Guarantee Fund
   01 Traumatic Injury
   02 Occupational Disease                                                                LUMP SUM PAYMENT/
      Cumulative Injury                                                               SETTLEMENT CODE (DN0293)
   03
      (other than disease)                                             SF    Settlement Full                                                         PARTIAL DENIAL CO
                                                                       SP    Settlement Partial
                                                                       AS    Agreement Stipulated
                    WAGE PERIOD CODE (DN0063)                          AW    Award
 FROI:               SROI:
                       01  Weekly
                                                                                       NON-CONSECUTIVE PERIOD
                                                                                            CODE (DN0212)

                                                                                                                                              REDUCED BENEFIT AMOUN

 NATURE OFINJURY CODE (DN0035)
 https://www.iisprojects.com/WCIO/pub/PNC/WCIO_Part_Table.pdf        CAUSE OF INJURY CODE (DN0037)
                                                                     https://www.iisprojects.com/WCIO/pub/PNC/WCIO_Cause_Table.pdf   PART OF BODY INJURED CODE (DN
                                                                                                                                     https://www.iisprojects.com/WCIO/pub/PN
be557e80-957c-4f44-b3f2-3cdff024a54e.xls                                                                                             Part of Body Code "99 - Whole Body" is n
                                                       Claims R3 Quick Code Reference List - Virginia
                                                   OTHER BENEFIT TYPE CODE (OBT's) (DN0216)
                                                   Total Claimant's Legal Expenses
                                                   Total Payments to Physicians
                                                   Total Hospital Costs
                                                   Total Other Medical
                                                   Total Unallocated Prior Indemnity Benefits
                                                   Total Unallocated Prior Medical
                                                   Total Pharmaceutical Costs
                                                   Total Dental Expenses
                                                   Total Physical Therapy Costs
                                                   Total Chiropractic Expenses




                                                      BENEFIT ADJUSTMENT CODE (DN0092)
                                                   Subrogation
                                                   Cost of Living Adjustment




                                                          BENEFIT CREDIT CODE (DN0126)




                                                     BENEFIT REDISTRIBUTION CODE (DN0130)




                                                         INITIAL TREATMENT CODE (DN0039)




                                                          PARTIAL DENIAL CODE (DN0294)




                                                    REDUCED BENEFIT AMOUNT CODE (DN0202)




                                           PART OF BODY INJURED CODE (DN0036)
                                           https://www.iisprojects.com/WCIO/pub/PNC/WCIO_Part_Table.pdf
be557e80-957c-4f44-b3f2-3cdff024a54e.xls   Part of Body Code "99 - Whole Body" is not valid in VA
            FULL DENIAL REASON CODE (DN0198)                                                         LATE REASON CODE (DN0077)
  1    No Compensable Accident                                   Delays
          A    Coming and Going                                              L1     No Excuse
          B    Horseplay                                                     L2     Late Notification, Employer
         C     Willful Intent To Injure Oneself                              L3     Late Notification, Employee
         D     Not Statutory Definition of Accident                          L4     Late Notification, Jurisdiction Transfer
          E    Deviation From Employment                                     L5     Late Notification, Health Care Provider
          F    Recreational/Social Activity                                  L6     Late Notification, Assigned Risk
         G     Traveling Employee                                            L7     Late Investigation
         H     Subsequent Intervening Accident                               L8     Tech Processing Delay, Computer Failure
  2    No Causal Relationship                                                L9     Manual Processing Delay
          A    Idiopathic Condition                                          LA     Intermittent Lost Time Prior To 1st Pymnt
          B    Pre-existing Condition                                        LB     Late notification/payment due to a Natural Disaster
         C     Stress non-work related                                       LC     Late notification/payment due to an act of Terrorism
         D     No Medical Evidence of Injury                     Coverage
          E    No Injury Per Statutory Definition                            C1     Coverage Lack Of Information
          F    Accident not major contributing cause of injury   Errors
  3    No Coverage                                                           E1     Wrongful Determination of No Coverage
          A    No Employee/Employer Relationship                             E2     Errors From Employer
          B    Independent Contractor                                        E3     Errors From Employee
         C     Not Statutory Definition of Employee                          E4     Errors From Jurisdiction
         D     No Jurisdiction                                               E5     Errors From Health Care Provider
          E    No Policy in Effect On Date of Accident                       E6     Errors From Other Claim Admin/IA/TPA
          F    Statute of Limitation Expired                     Disputes
               Statutory Exemptions                                          D1     Dispute Concerning Coverage
         G
               (Sole Proprietor, Corporate Officer, etc)                     D2     Dispute Concern, Compensability in Whole
               Elected Other Coverage                                        D3     Dispute Concern, Compensability in Part
         H
               (24 hr, Collective Bargaining, Opted Out)                     D4     Dispute Concerning Disability in Whole
          I    Employee not reported to PEO                                  D5     Dispute Concerning Disability in Part
  4    Substance Use/Abuse                                                   D6     Dispute Concerning Impairment
               Injury Primarily Occasioned by
          A
               Intoxication or Use of Any Drug                                ACCIDENT PREMISES CODE                                AGREEMENT TO COMPENSATE
               Substance Use/Abuse, Violation of                                     (DN0249)                                            CODE (DN0075)
          B
               Drug-Free Work Place Policy in effect
  5    Other (Not Elsewhere Classified)
          A    Failure To Report Accident Timely
          B    Right To Reserve                                                                                               CLAIM STATUS CODE (DN0073)
         C     Misrepresentation                                              EMPLOYEE GENDER CODE                             O Open
                                                                                    (DN0053)                                   C Closed
           EMPLOYMENT STATUS CODE (DN0058)                         M      Male                                                 R Re-Open
                 (In Hierarchical Order)                           F      Female                                               X Re-Open/Closed
                                                                   U      Unknown
                                                                                                                                             DEATH RESULT OF
                                                                          EMPLOYEE MARITAL STATUS CODE                                     INJURY CODE (DN0146)
                                                                                       (DN0054)                                 Y Yes
                                                                   U      Unmarried, Widowed, Divorced, Single                  N No
                                                                   M      Married                                               U Unknown
                                                                   S      Separated
                                                                   K      Unknown                                                          EMPLOYEE TAX FILING
                                                                                                                                           STATUS CODE (DN0158)
                                                                            PRE-EXISTING DISABILITY CODE
                                                                                      (DN0069)



          RETURN TO WORK TYPE CODE (DN0189)
  A    Actual
  R    Released                                                                   RECOVERY CODE (DN0226)                                 DEPENDENT/PAYEE
                                                                                                                                  RELATIONSHIP CODE (DN0097)
         EMPLOYEE ID TYPE QUALIFIER (DN0270)                                                                                    R Relationship
  A    Employee ID Assigned by Jurisdiction                                                                                         2    Widow
  E    Employee Employment Visa                                                                                                     3    Widower
  G    Employee Green Card                                                                                                          4    Son/Daughter
  P    Employee Passport Number                                                                                                     6    Mother/Father
  S    Employee Social Security Number                                                                                              7    Disabled Child
                                                                                                                                    8    Jurisdiction Fund/Estate

         APPLICATION ACKNOWLEDGMENT CODE
(DN0111)                                                                                                                        N Numerical Birth Order (0-9)
  HD Batch Rejected                                                                                                                 0   Jurisdiction Fund
  TA Transaction Accepted
  TN Transaction Rejected by Service Provider
  TR Transaction Rejected

                                                                                        MANAGED CARE ORGANIZATION (MCO) CODE (DN0207)
                TRANSACTION SET ID (DN0001)                      http://www.iaiabc.org/EDI/implementation.asp
 148   First Report
 R21   First Report Companion Record                                                   ACKNOWLEDGMENT TRANSACTION SET ID (DN0110)
 A49   Subsequent Report                                          148     First Report
 R22   Subsequent Report Companion Record                         A49     Subsequent Report
 AKC   Claims Acknowledgment Detail Record
 ARC   Claims Re-Acknowledgment Detail Record                                                        INTERCHANGE VERSION ID (DN0105)
 HD1   Transmission Header Record                                14830    First Report of Injury; Release 3, Version 0
 TR2   Transmission Trailer Record                               A4930    Subsequent Report of Injury; Release 3, Version 0
                                                                 AKC30    Claims Acknowledgment Detail Record; Release 3, Version 0
              TEST/PRODUCTION CODE (DN0104)                      ARC30    Claims Re-Acknowledgment Detail Record; Release 3, Version 0
  P    Production
  T    Test (Pilot Parallel or Test)
Element#   Element Name
 DN0249    Accident Premises Codes
 DN0110    Acknowledgment Transaction Set ID
 DN0075    Agreement to Compensate Codes
 DN0111    Application Acknowledgment Code
 DN0092    Benefit Adjustment Codes
 DN0126    Benefit Credit Codes
 DN0130    Benefit Redistribution Codes
 DN0085    Benefit Type Codes
 DN0073    Claim Status Codes
 DN0074    Claim Type Codes
 DN0146    Death Result of Injury Codes
 DN0097    Dependent/Payee Relationship Codes
 DN0053    Employee Gender Codes
 DN0270    Employee ID Type Qualifier
 DN0054    Employee Marital Status Codes
 DN0158    Employee Tax Filing Status Codes
 DN0058    Employment Status Codes
 DN0198    Full Denial Reason Codes
 DN0039    Initial Treatment Codes
 DN0184    Insured Type Codes
 DN0185    Insurer Type Codes
 DN0105    Interchange Version ID
 DN0077    Late Reason Codes
 DN0293    Lump Sum Payment/Settlement Codes
 DN0002    Maintenance Type Codes
 DN0207    Managed Care Organization Codes
 DN0212    Non-Consecutive Period Codes
 DN0216    Other Benefit Type Codes
 DN0294    Partial Denial Codes
 DN0069    Pre-Existing Disability Codes
 DN0226    Recovery Codes
 DN0202    Reduced Benefit Amount Code
 DN0189    Return to Work Type Codes
 DN0104    Test/Production Code
 DN0001    Transaction Set ID
 DN0290    Type of Loss Codes
 DN0063    Wage Period Codes

				
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