CLM Health Claim
To specify basic data about the claim
Position
Element
Name
Type
Requirement
Min
Max
Repeat
Identifier used to track a claim from creation by the health care provider through payment
Monetary amount
CLM02 is the total amount of all submitted charges of service segments for this claim.
Code identifying type of claim
Code identifying the type of provider or claim
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.
C023-01 does not contain the last position of the Uniform Bill Type Code (the Claim Frequency Code).
Code identifying the type of facility referenced
C023-02 qualifies C023-01 and C023-03.
Code specifying the frequency of the claim; this is the third position of the Uniform Billing Claim Form Bill Type
Code indicating a Yes or No condition or response
CLM06 is provider signature on file indicator. A "Y" value indicates the provider signature is on file; an "N" value indicates the provider signature is not on file.
Code indicating whether the provider accepts assignment
Code indicating a Yes or No condition or response
CLM08 is assignment of benefits indicator. A "Y" value indicates insured or authorized person authorizes benefits to be assigned to the provider; an "N" value indicates benefits have not been assigned to the provider.
Code indicating whether the provider has on file a signed statement by the patient authorizing the release of medical data to other organizations
Code indicating how the patient or subscriber authorization signatures were obtained and how they are being retained by the provider
Code identifying an accompanying cause of an illness, injury or an accident
Code identifying an accompanying cause of an illness, injury or an accident
Code identifying an accompanying cause of an illness, injury or an accident
Code (Standard State/Province) as defined by appropriate government agency
C024-04 and C024-05 apply only to auto accidents when C024-01, C024-02, or C024-03 is equal to "AA".
Code identifying the country
Code indicating the Special Program under which the services rendered to the patient were performed
Code indicating a Yes or No condition or response
CLM13 is CHAMPUS nonavailability indicator. A "Y" value indicates a statement of non-availability is on file; an "N" value indicates statement of nonavailability is not on file or not necessary.
Code specifying the level of service rendered
Code indicating a Yes or No condition or response
CLM15 is charges itemized by service indicator. A "Y" value indicates charges are itemized by service; an "N" value indicates charges are summarized by service.
Code indicating the type of agreement under which the provider is submitting this claim
Code identifying the status of an entire claim as assigned by the payor, claim review organization or repricing organization
Code indicating a Yes or No condition or response
CLM18 is explanation of benefit (EOB) indicator. A "Y" value indicates that a paper EOB is requested; an "N" value indicates that no paper EOB is requested.
Code identifying reason for claim submission
Code indicating the reason why a request was delayed