Ref	Id	Element Name	Req	Type	Min/Max	Usage
CLP01	1028	Claim Submitter's Identifier Description: Identifier used to track a claim from creation by the health care provider through payment Industry: Patient Control Number Use this number for the patient control number assigned by the provider. If the patient control number is not present on the incoming claim, enter zero. The value in CLP01 must be identical to any value received as a Claim Submitter’s Identifier on the original claim (CLM01 of the ANSI ASC X12 837, if applicable). This data element is the primary key for posting the remittance information into the provider’s database.	M	AN	1/38	Required
CLP02	1029	Claim Status Code Description: Code identifying the status of an entire claim as assigned by the payor, claim review organization or repricing organization	M	ID	1/2	Required

Code

Name

Processed as Primary

Processed as Secondary

Processed as Tertiary

Denied

Pended

NOT ADVISED
Claims with this status should be reported in the Claim Status (277) transaction when the payer implements it.

Received, but not in process

NOT ADVISED
Claims with this status should be reported in the Claim Status (277) transaction when the payer implements it.

Suspended

NOT ADVISED
Claims with this status should be reported in the Claim Status (277) transaction when the payer implements it.

Suspended - investigation with field

NOT ADVISED
Claims with this status should be reported in the Claim Status (277) transaction when the payer implements it.

Suspended - return with material

NOT ADVISED
Claims with this status should be reported in the Claim Status (277) transaction when the payer implements it.

Suspended - review pending

NOT ADVISED
Claims with this status should be reported in the Claim Status (277) transaction when the payer implements it.

Processed as Primary, Forwarded to Additional Payer(s)

Processed as Secondary, Forwarded to Additional Payer(s)

Processed as Tertiary, Forwarded to Additional Payer(s)

Reversal of Previous Payment

Not Our Claim, Forwarded to Additional Payer(s)

Predetermination Pricing Only - No Payment

Reviewed

NOT ADVISED
Claims with this status should be reported in the Claim Status (277) transaction when the payer implements it.

CLP03	782	Monetary Amount Description: Monetary amount Industry: Total Claim Charge Amount See 2.2.1, Balancing, in this implementation guide for additional information. This amount does not include interest. Use this monetary amount for the submitted charges for this claim. The amount can be zero or less, but the value in BPR02 may not be negative.	M	R	1/18	Required
CLP04	782	Monetary Amount Description: Monetary amount Industry: Claim Payment Amount See 2.2.1, Balancing, in this implementation guide for additional information. This amount does not include interest. Use this monetary amount for the amount paid for this claim. It can be zero or less, but the value in BPR02 may not be negative.	M	R	1/18	Required
CLP05	782	Monetary Amount Description: Monetary amount Industry: Patient Responsibility Amount Amounts in CLP05 should have supporting adjustments reflected in CAS segments at the CLP or SVC loop level with a Claim Adjustment Group (CAS01) code of PR (Patient Responsibility). Use this monetary amount for the payer’s statement of he patient responsibility amount for this claim, which can include such items as deductible, non-covered services, co-pay, and co-insurance. This amount must be entered if it is greater than zero. See 2.2.1, Balancing, and 2.2.9, Interest and Prompt Payment Discounts, for additional information. For Medicare, this must be reported by carriers but is not used by intermediaries.	O	R	1/18	Recommended
CLP06	1032	Claim Filing Indicator Code Description: Code identifying type of claim For many providers to electronically post the 835 remittance data to their patient accounting systems without human intervention, a unique, provider-specific insurance plan code is needed. This code allows the provider to separately identify and manage the different product lines or contractual arrangements between the payer and the provider. Because most payers maintain the same Originating Company Identifier in the TRN03/BPR10 for all product lines or contractual relationships, the CLP06 is used by the provider as a table pointer in combination with the TRN03/BPR10 to identify the unique, provider-specific insurance plan code needed to post the payment without human intervention. The value should mirror the value received in the original claim (2-005 SBR09 of the 837), if applicable, or provide the value as assigned or edited by the payer.	O	ID	1/2	Required

Code

Name

Preferred Provider Organization (PPO)

Use this code for Blue Cross/Blue Shield par arrangements.

Point of Service (POS)

Exclusive Provider Organization (EPO)

Indemnity Insurance

Use this code for Blue Cross/Blue Shield non-par arrangements.

Health Maintenance Organization (HMO) Medicare Risk

Automobile Medical

Champus

Disability

Health Maintenance Organization

Liability Medical

Medicare Part A

Medicare Part B

Medicaid

Other Federal Program

Use this code for the Black Lung Program.

Title V

Veteran Administration Plan

Workers' Compensation Health Claim

CLP07	127	Reference Identification Description: Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier Industry: Payer Claim Control Number Use this number for the payer’s internal control number. This number must apply to the entire claim. Report service variations at the SVC loop. This must be provided whenever the PAYER assigns an internal claim number and desires this reference from the provider as a part of any customer service contact or appeal process.	O	AN	1/30	Recommended
CLP08	1331	Facility Code Value Description: Code identifying the type of facility where services were performed; the first and second positions of the Uniform Bill Type code or the Place of Service code from the Electronic Media Claims National Standard Format Industry: Facility Type Code State the facility code here when the submitted code has been modified through adjudication. This code is expected to be from the same code list as that identified in the original claim. This number was received in CLM05-1 of the 837 claim.	O	AN	1/2	Situational
CLP09	1325	Claim Frequency Type Code Description: Code specifying the frequency of the claim; this is the third position of the Uniform Billing Claim Form Bill Type Industry: Claim Frequency Code CODE SOURCE: 235: Claim Frequency Type Code This data element is specific to institutional claims and is required when it was received on the original claim. This does not apply to other types of claims. This number was received in CLM05-2 of the 837 claim.	O	ID	1/1	Situational

	CLP12	380	Quantity Description: Numeric value of quantity Industry: Diagnosis Related Group (DRG) Weight This data element is specific to institutional claims and is required when adjudication considers the DRG. This does not apply to other types of claims. Use this number for the DRG Weight.	O	R	1/15	Situational
	CLP13	954	Percent Description: Percentage expressed as a decimal Industry: Discharge Fraction This data element is specific to institutional claims and is required when considered in the adjudication process. This does not apply to other types of claims. Use this number for the discharge fraction.	O	R	1/10	Situational

1.	CLP03 is the amount of submitted charges this claim.
2.	CLP04 is the amount paid this claim.
3.	CLP05 is the patient responsibility amount.
4.	CLP07 is the payer's internal control number.
5.	CLP12 is the diagnosis-related group (DRG) weight.
6.	CLP13 is the discharge fraction.

	ExternalCodeList
	Name: 235
	Description: Claim Frequency Type Code

	ExternalCodeList
	Name: 229
	Description: Diagnosis Related Group Number (DRG)