CLP Claim Level Data

To supply information common to all services of a claim

Position
Element
Name
Type
Requirement
Min
Max
Repeat
CLP-01
Claim Submitter's Identifier
String (AN)
Mandatory
1
38
-
Identifier used to track a claim from creation by the health care provider through payment.
CLP-02
Claim Status Code
Identifier (ID)
Mandatory
1
2
-
Code identifying the status of an entire claim as assigned by the payor, claim review organization or repricing organization
CLP-03
Monetary Amount
Decimal number (R)
Mandatory
1
15
-
Monetary amount.
CLP03 is the amount of submitted charges this claim.
CLP-04
Monetary Amount
Decimal number (R)
Mandatory
1
15
-
Monetary amount.
CLP04 is the amount paid this claim.
CLP-05
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
CLP05 is the patient responsibility amount.
CLP-06
Claim Filing Indicator Code
Identifier (ID)
Optional
1
2
-
Code identifying type of claim
CLP-07
Reference Number
String (AN)
Optional
1
30
-
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.
CLP-08
Facility Code Value
String (AN)
Optional
1
2
-
Code identifying the type of facility where services were performed; the first and second positions of the Uniform Bill Type code or the Place of Service code from the Electronic Media Claims National Standard Format
CLP-09
Claim Frequency Type Code
Identifier (ID)
Optional
1
1
-
Code specifying the frequency of the claim; this is the third position of the Uniform Billing Claim Form Bill Type
CLP-10
Patient Status Code
Identifier (ID)
Optional
1
2
-
Code indicating patient status as of the ``statement covers through date''
CLP-11
Diagnosis Related Group (DRG) Code
Identifier (ID)
Optional
1
4
-
Code indicating a patient's diagnosis group based on a patient's illness, diseases, and medical problems
CLP-12
Quantity
Decimal number (R)
Optional
1
15
-
Numeric value of quantity.
CLP12 is the diagnosis-related group (DRG) weight.

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