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: 1

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: 1

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: 18 · Repeat: 1

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: 18 · Repeat: 1

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: 18 · Repeat: 1

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: 1

Code identifying type of claim

Position: CLP-07 · Element: 127 · Name: Reference Identification · Type: String (AN) · Requirement: Optional · Min: 1 · Max: 80 · Repeat: 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.

Position: CLP-08 · Element: 1331 · Name: Facility Code Value · Type: String (AN) · Requirement: Optional · Min: 1 · Max: 3 · Repeat: 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.

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

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

Code indicating patient status as of the "statement covers through date"

CLP-11 C022 Health Care Code Information Composite (composite) Conditional 1

Position: 01 · Element: 1270 · Name: Code List Qualifier Code · Type: Identifier (ID) · Requirement: Mandatory · Min: 1 · Max: 3 · Repeat: -

Code identifying a specific industry code list

C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08.

Position: 02 · Element: 1271 · Name: Industry Code · Type: String (AN) · Requirement: Mandatory · Min: 1 · Max: 30 · Repeat: -

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.

Position: 03 · Element: 1250 · Name: Date Time Period Format Qualifier · Type: Identifier (ID) · Requirement: Conditional · Min: 2 · Max: 3 · Repeat: -

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.

Position: 04 · Element: 1251 · Name: Date Time Period · Type: String (AN) · Requirement: Conditional · Min: 1 · Max: 35 · Repeat: -

Expression of a date, a time, or range of dates, times or dates and times

Position: 05 · Element: 782 · Name: Monetary Amount · Type: Decimal number (R) · Requirement: Optional · Min: 1 · Max: 18 · Repeat: -

Monetary amount

Position: 06 · Element: 380 · Name: Quantity · Type: Decimal number (R) · Requirement: Optional · Min: 1 · Max: 15 · Repeat: -

Numeric value of quantity

Position: 07 · Element: 799 · Name: Version Identifier · Type: String (AN) · Requirement: Optional · Min: 1 · Max: 30 · Repeat: -

Revision level of a particular format, program, technique or algorithm

C022-07 qualifies C022-01.

Position: 08 · Element: 1271 · Name: Industry Code · Type: String (AN) · Requirement: Conditional · Min: 1 · Max: 30 · Repeat: -

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.

Position: 09 · Element: 1271 · Name: Industry Code · Type: String (AN) · Requirement: Conditional · Min: 1 · Max: 30 · Repeat: -

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.

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

Numeric value of quantity

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

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

Percentage expressed as a decimal (e.g., 0.0 through 1.0 represents 0% through 100%)

CLP13 is the discharge fraction.

Position: CLP-14 · Element: 1073 · Name: Yes/No Condition or Response Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 1 · Repeat: 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.

Position: CLP-15 · Element: 280 · Name: Exchange Rate · Type: Decimal number (R) · Requirement: Optional · Min: 4 · Max: 10 · Repeat: 1

Value to be used as a multiplier conversion factor to convert monetary value from one currency to another