CLP Claim Level Data

Mandatory

AtMax 1

To supply information common to all services of a claim

Elements

Position	Element	Name		Type	Min/Max	Repeat

1	1028	Claim Submitter's Identifier	Mandatory	Alphanumeric	1/38	AtMax 1
2	1029	Claim Status Code	Mandatory	ID	1/2	AtMax 1
3	782	Monetary Amount	Mandatory	Decimal	1/18	AtMax 1
4	782	Monetary Amount	Mandatory	Decimal	1/18	AtMax 1
5	782	Monetary Amount	Opt	Decimal	1/18	AtMax 1
6	1032	Claim Filing Indicator Code	Opt	ID	1/2	AtMax 1
7	127	Reference Identification	Opt	Alphanumeric	1/80	AtMax 1
8	1331	Facility Code Value	Opt	Alphanumeric	1/3	AtMax 1
9	1325	Claim Frequency Type Code	Opt	ID	1/1	AtMax 1
10	1352	Patient Status Code	Opt	ID	1/2	AtMax 1
11	1354	Diagnosis Related Group (DRG) Code	Opt	ID	1/4	AtMax 1
12	380	Quantity	Opt	Decimal	1/15	AtMax 1
13	954	Percentage as Decimal	Opt	Decimal	1/10	AtMax 1
14	1073	Yes/No Condition or Response Code	Opt	ID	1/1	AtMax 1
15	280	Exchange Rate	Opt	Decimal	4/10	AtMax 1

Element Details

ID1028

NameClaim Submitter's Identifier

LengthMin 1 / Max 38

Position1

RequirementMandatory