CLP Claim Level Data

To supply information common to all services of a claim

Position: CLP-01 · Element: 1028 · Name: Claim Submitter's Identifier · Type: String (AN) · Requirement: Mandatory · Min: 1 · Max: 38 · Repeat: -

Identifier used to track a claim from creation by the health care provider through payment.

Position: CLP-02 · Element: 1029 · Name: Claim Status Code · Type: Identifier (ID) · Requirement: Mandatory · Min: 1 · Max: 2 · Repeat: -

Code identifying the status of an entire claim as assigned by the payor.

Position: CLP-03 · Element: 782 · Name: Monetary Amount · Type: Decimal number (R) · Requirement: Mandatory · Min: 1 · Max: 15 · Repeat: -

Monetary amount.

CLP03 is the amount of submitted charges this claim.

Position: CLP-04 · Element: 782 · Name: Monetary Amount · Type: Decimal number (R) · Requirement: Mandatory · Min: 1 · Max: 15 · Repeat: -

Monetary amount.

CLP04 is the amount paid this claim.

Position: CLP-05 · Element: 782 · Name: Monetary Amount · Type: Decimal number (R) · Requirement: Optional · Min: 1 · Max: 15 · Repeat: -

Monetary amount.

CLP05 is the patient responsibility amount.

Position: CLP-06 · Element: 1032 · Name: Claim Filing Indicator Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 2 · Repeat: -

Code identifying type of claim

Position: CLP-07 · Element: 127 · Name: Reference Number · Type: String (AN) · Requirement: Optional · Min: 1 · Max: 30 · Repeat: -

Reference number or identification number as defined for a particular Transaction Set, or as specified by the Reference Number Qualifier.

CLP07 is the payer's internal control number.

Position: CLP-08 · Element: 1331 · Name: Facility Code Value · Type: String (AN) · Requirement: Optional · Min: 1 · Max: 2 · Repeat: -

Code identifying the type of facility where services were performed; the first and second position of the uniform bill type or place of service from health care financing administration claim form, or place of treatment from the dental claim form

Position: CLP-09 · Element: 1325 · Name: Claim Frequency Type Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 1 · Repeat: -

Code specifying the frequency of the claim; this is the third position of the Uniform Billing Claim Form Bill Type

Position: CLP-10 · Element: 1352 · Name: Patient Status Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 2 · Repeat: -

Code indicating patient status as of the ``statement covers through date''

Position: CLP-11 · Element: 1354 · Name: Diagnosis Related Group (DRG) Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 4 · Repeat: -

Code indicating a patient's diagnosis group based on a patient's illness, diseases, and medical problems