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
1
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
1
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
18
1
Monetary amount
CLP03 is the amount of submitted charges this claim.
CLP-04
Monetary Amount
Decimal number (R)
Mandatory
1
18
1
Monetary amount
CLP04 is the amount paid this claim.
CLP-05
Monetary Amount
Decimal number (R)
Optional
1
18
1
Monetary amount
CLP05 is the patient responsibility amount.
CLP-06
Claim Filing Indicator Code
Identifier (ID)
Optional
1
2
1
Code identifying type of claim
CLP-07
Reference Identification
String (AN)
Optional
1
50
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.
CLP-08
Facility Code Value
String (AN)
Optional
1
2
1
Code identifying where services were, or may be, performed; the first and second positions of the Uniform Bill Type Code for Institutional Services or the Place of Service Codes for Professional or Dental Services.
CLP-09
Claim Frequency Type Code
Identifier (ID)
Optional
1
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
1
Code indicating patient status as of the "statement covers through date"
CLP-11
Diagnosis Related Group (DRG) Code
Identifier (ID)
Optional
1
4
1
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
1
Numeric value of quantity
CLP12 is the diagnosis-related group (DRG) weight.
CLP-13
Percentage as Decimal
Decimal number (R)
Optional
1
10
1
Percentage expressed as a decimal (e.g., 0.0 through 1.0 represents 0% through 100%)
CLP13 is the discharge fraction.
CLP-14
Yes/No Condition or Response Code
Identifier (ID)
Optional
1
1
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.

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