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 Discharge Status | Opt | ID | 1/2 | AtMax 1 | |
AtMax 1 | |||||||
| 12 | 380 | Quantity | Rel | 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 | |
| 16 | 1732 | Source of Payment Typology Code | Opt | ID | 2/6 | AtMax 1 | |
Element Details
ID1028
NameClaim Submitter's Identifier
LengthMin 1 / Max 38
Position1
RequirementMandatory