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, claim review organization or repricing organization

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 Identification · Type: String (AN) · Requirement: Optional · Min: 1 · Max: 30 · Repeat: -

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.

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 positions of the Uniform Bill Type code or the Place of Service code from the Electronic Media Claims National Standard Format

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

Position: CLP-12 · Element: 380 · Name: Quantity · Type: Decimal number (R) · Requirement: Optional · Min: 1 · Max: 15 · Repeat: -

Numeric value of quantity

CLP12 is the diagnosis-related group (DRG) weight.

Position: CLP-13 · Element: 954 · Name: Percent · Type: Decimal number (R) · Requirement: Optional · Min: 1 · Max: 10 · Repeat: -

Percentage expressed as a decimal

CLP13 is the discharge fraction.