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Segment
in
X12 Release 003030

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
-
Identifier used to track a claim from creation by the health care provider through payment.
02
Claim Status Code
Identifier (ID)
Mandatory
1
2
-
Code identifying the status of an entire claim as assigned by the payor.
Codes (23)
03
Monetary Amount
Decimal number (R)
Mandatory
1
15
-
Monetary amount.
CLP03 is the amount of submitted charges this claim.
04
Monetary Amount
Decimal number (R)
Mandatory
1
15
-
Monetary amount.
CLP04 is the amount paid this claim.
05
Monetary Amount
Decimal number (R)
Optional
1
15
-
Monetary amount.
CLP05 is the patient responsibility amount.
06
Claim Filing Indicator Code
Identifier (ID)
Optional
1
2
-
Code identifying the type of health insurance or program.
Codes (15)
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.
08
Facility Code
Identifier (ID)
Optional
1
2
-
Code identifying the type of facility where services were performed; the first position of the uniform bill type or place of service from health care financing administration claim form or place of treatment from the dental claim form
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
10
Patient Status Code
Identifier (ID)
Optional
1
2
-
Code indicating patient status as of the ``statement covers through date''
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
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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.