EDI
API DocsTerminal

CLP Claim Level Data

To supply information common to all services of a claim

Sequence
Element
Name
Type
Requirement
Min
Max
Repeat
01
1028
Claim Submitter's Identifier
String (AN)
Mandatory
1
38
1
Identifier used to track a claim from creation by the health care provider through payment
02
Claim Status Code
Identifier (ID)
Mandatory
1
2
1
Code identifying the status of an entire claim as assigned by the payor, claim review organization or repricing organization
Codes (46)
03
Monetary Amount
Decimal number (R)
Mandatory
1
18
1
Monetary amount
CLP03 is the amount of submitted charges this claim.
04
Monetary Amount
Decimal number (R)
Mandatory
1
18
1
Monetary amount
CLP04 is the amount paid this claim.
05
Monetary Amount
Decimal number (R)
Optional
1
18
1
Monetary amount
CLP05 is the patient responsibility amount.
06
Claim Filing Indicator Code
Identifier (ID)
Optional
1
2
1
Code identifying type of claim
Codes (52)
07
Reference Identification
String (AN)
Optional
1
80
1
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
CLP07 is the payer's internal control number.
08
Facility Code Value
String (AN)
Optional
1
3
1
Code identifying where services were, or may be, performed; the National Uniform Billing Committee (NUBC) Facility Type Code for Institutional Services or the Place of Service Codes for Professional or Dental Services.
09
Claim Frequency Type Code
Identifier (ID)
Optional
1
1
1
Code specifying the Type of Bill Frequency Code. It is the last digit of Type of Bill in the UB manual, as defined by the National Uniform Billing Committee
10
Patient Discharge Status
Identifier (ID)
Optional
1
2
1
A code indicating the disposition or discharge status of the patient as of the discharge date.
11
Health Care Code Information
Composite (composite)
Conditional
1
01
Code List Qualifier Code
Identifier (ID)
Mandatory
1
3
-
Code identifying a specific industry code list
C022-01 qualifies C022-02, C022-04, C022-05, C022-06, C022-08 and C022-10.
Codes (1056)
02
Industry Code
String (AN)
Mandatory
1
30
-
Code indicating a code from a specific industry code list
If C022-08 is used, then C022-02 represents the beginning value in a range of codes.
03
Date Time Period Format Qualifier
Identifier (ID)
Conditional
2
3
-
Code indicating the date format, time format, or date and time format
P0304: If either C022-03 or C022-04 is present, then the other is required
C022-03 is the date format that will appear in C022-04.
Codes (42)
04
Date Time Period
String (AN)
Conditional
1
35
-
Expression of a date, a time, or range of dates, times or dates and times
05
Monetary Amount
Decimal number (R)
Optional
1
18
-
Monetary amount
06
Quantity
Decimal number (R)
Optional
1
15
-
Numeric value of quantity
07
Version Identifier
String (AN)
Optional
1
30
-
Revision level of a particular format, program, technique or algorithm
C022-07 qualifies C022-01.
08
Industry Code
String (AN)
Conditional
1
30
-
Code indicating a code from a specific industry code list
E0809: Only one of C022-08 or C022-09 may be present
C022-08 represents the ending value in a range of codes.
09
Industry Code
String (AN)
Conditional
1
30
-
Code indicating a code from a specific industry code list
C022-09 is a value from Code Source 959 for the Present on Admission Indicator.
C022-09 would only need to be reported when C022-02 is a Diagnosis Code and range of diagnosis codes were NOT given in C022-08.
10
Industry Code
String (AN)
Optional
1
30
-
Code indicating a code from a specific industry code list
C022-10 is the attribute of the code in C022-02 from the same code list.
12
Quantity
Decimal number (R)
Conditional
1
15
1
Numeric value of quantity
CLP12 is the diagnosis-related group (DRG) weight.
13
Percentage as Decimal
Decimal number (R)
Optional
1
10
1
Percentage expressed as a decimal (e.g., 0.0 through 1.0 represents 0% through 100%)
CLP13 is the discharge fraction.
14
Yes/No Condition or Response Code
Identifier (ID)
Optional
1
1
1
Code indicating a Yes or No condition or response
CLP14 is the patient authorization to coordinate benefits. A "Y" indicates that the authorization exists; an "N" indicates that the authorization does not exist.
Codes (9)
15
Exchange Rate
Decimal number (R)
Optional
4
10
1
Value to be used as a multiplier conversion factor to convert monetary value from one currency to another
16
Source of Payment Typology Code
Identifier (ID)
Optional
2
6
1
Code identifying payer types in the most granular way
CLP16 is the Source of Payment Typology Code (see Code Source 944).

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Stedi is a registered trademark of Stedi, Inc. Stedi's EDI Reference and Mapping Guides are provided for marketing purposes and are free of charge. All names, logos, and brands of third parties listed on our site are trademarks of their respective owners (including “X12”, which is a trademark of X12 Incorporated). Stedi, Inc. and its products and services are not endorsed by, sponsored by, or affiliated with these third parties. Our use of these names, logos, and brands is for identification purposes only, and does not imply any such endorsement, sponsorship, or affiliation.