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
80
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
3
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.
CLP-09
Claim Frequency Type Code
Identifier (ID)
Optional
1
1
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
CLP-10
Patient Discharge Status
Identifier (ID)
Optional
1
2
1
A code indicating the disposition or discharge status of the patient as of the discharge date.
CLP-11
Health Care Code Information
Composite (composite)
Conditional
1
01
Code List Qualifier Code
Identifier (ID)
Mandatory
1
3
-
Code identifying a specific industry code list
C022-01 qualifies C022-02, C022-04, C022-05, C022-06, C022-08 and C022-10.
02
Industry Code
String (AN)
Mandatory
1
30
-
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.
03
Date Time Period Format Qualifier
Identifier (ID)
Conditional
2
3
-
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.
04
Date Time Period
String (AN)
Conditional
1
35
-
Expression of a date, a time, or range of dates, times or dates and times
05
Monetary Amount
Decimal number (R)
Optional
1
18
-
Monetary amount
06
Quantity
Decimal number (R)
Optional
1
15
-
Numeric value of quantity
07
Version Identifier
String (AN)
Optional
1
30
-
Revision level of a particular format, program, technique or algorithm
C022-07 qualifies C022-01.
08
Industry Code
String (AN)
Conditional
1
30
-
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.
09
Industry Code
String (AN)
Conditional
1
30
-
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.
10
Industry Code
String (AN)
Optional
1
30
-
Code indicating a code from a specific industry code list
C022-10 is the attribute of the code in C022-02 from the same code list.
CLP-12
Quantity
Decimal number (R)
Conditional
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.
CLP-15
Exchange Rate
Decimal number (R)
Optional
4
10
1
Value to be used as a multiplier conversion factor to convert monetary value from one currency to another
CLP-16
Source of Payment Typology Code
Identifier (ID)
Optional
2
6
1
Code identifying payer types in the most granular way
CLP16 is the Source of Payment Typology Code (see Code Source 944).

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