知行 EDI 规范查询平台™
Segment
X12 EDI Release 00304
CLPClaim Level Data
To supply information common to all services of a claim
Elements
  • CLP011028Claim Submitter's Identifier
    AN
    M必须(Mandatory)
    Min 1 / Max 38

    Identifier used to track a claim from creation by the health care provider through payment.

  • CLP021029Claim Status Code
    ID
    M必须(Mandatory)

    Code identifying the status of an entire claim as assigned by the payor.

    Codes (28)
  • CLP03782Monetary Amount
    R
    M必须(Mandatory)
    Min 1 / Max 15

    Monetary amount.

  • CLP04782Monetary Amount
    R
    M必须(Mandatory)
    Min 1 / Max 15

    Monetary amount.

  • CLP05782Monetary Amount
    R
    O可选(Optional)
    Min 1 / Max 15

    Monetary amount.

  • CLP061032Claim Filing Indicator Code
    ID
    O可选(Optional)

    Code identifying type of claim

    Codes (26)
  • CLP07127Reference Number
    AN
    O可选(Optional)
    Min 1 / Max 30

    Reference number or identification number as defined for a particular Transaction Set, or as specified by the Reference Number Qualifier.

  • CLP081331Facility Code Value
    AN
    O可选(Optional)
    Min 1 / Max 2

    Code identifying the type of facility where services were performed; the first and second position of the uniform bill type or place of service from health care financing administration claim form, or place of treatment from the dental claim form

  • CLP091325Claim Frequency Type Code
    ID
    O可选(Optional)
    Min 1 / Max 1

    Code specifying the frequency of the claim; this is the third position of the Uniform Billing Claim Form Bill Type

  • CLP101352Patient Status Code
    ID
    O可选(Optional)
    Min 1 / Max 2

    Code indicating patient status as of the ``statement covers through date''

  • CLP111354Diagnosis Related Group (DRG) Code
    ID
    O可选(Optional)
    Min 1 / Max 4

    Code indicating a patient's diagnosis group based on a patient's illness, diseases, and medical problems

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