Segment
X12 EDI Release 00402
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, claim review organization or repricing organization

    Codes (41)
  • CLP03782Monetary Amount
    R
    M必须(Mandatory)
    Min 1 / Max 18

    Monetary amount

  • CLP04782Monetary Amount
    R
    M必须(Mandatory)
    Min 1 / Max 18

    Monetary amount

  • CLP05782Monetary Amount
    R
    O可选(Optional)
    Min 1 / Max 18

    Monetary amount

  • CLP061032Claim Filing Indicator Code
    ID
    O可选(Optional)

    Code identifying type of claim

    Codes (45)
  • CLP07127Reference Identification
    AN
    O可选(Optional)
    Min 1 / Max 30

    Reference information as defined for a particular Transaction Set or as specified by the Reference Identification 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 positions of the Uniform Bill Type code or the Place of Service code from the Electronic Media Claims National Standard Format

  • 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

  • CLP12380Quantity
    R
    O可选(Optional)
    Min 1 / Max 15

    Numeric value of quantity

  • CLP13954Percent
    R
    O可选(Optional)
    Min 1 / Max 10

    Percentage expressed as a decimal