知行 EDI 规范查询平台™
Segment
X12 EDI Release 00403
CLMHealth Claim
To specify basic data about the claim
Elements
  • CLM011028Claim 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

  • CLM02782Monetary Amount
    R
    O可选(Optional)
    Min 1 / Max 18

    Monetary amount

  • CLM031032Claim Filing Indicator Code
    ID
    O可选(Optional)

    Code identifying type of claim

    Codes (45)
  • CLM041343Non-Institutional Claim Type Code
    ID
    O可选(Optional)

    Code identifying the type of provider or claim

    Codes (47)
  • CLM05C023Health Care Service Location InformationO可选(Optional)
    133113321325
    • CLM05011331Facility Code Value
      AN
      M必须(Mandatory)
      Min 0 / 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

    • CLM05021332Facility Code Qualifier
      ID
      O可选(Optional)

      Code identifying the type of facility referenced

      Codes (2)
    • CLM05031325Claim 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

  • CLM061073Yes/No Condition or Response Code
    ID
    O可选(Optional)

    Code indicating a Yes or No condition or response

    Codes (4)
  • CLM071359Provider Accept Assignment Code
    ID
    O可选(Optional)

    Code indicating whether the provider accepts assignment

    Codes (4)
  • CLM081073Yes/No Condition or Response Code
    ID
    O可选(Optional)

    Code indicating a Yes or No condition or response

    Codes (4)
  • CLM091363Release of Information Code
    ID
    O可选(Optional)

    Code indicating whether the provider has on file a signed statement by the patient authorizing the release of medical data to other organizations

    Codes (6)
  • CLM101351Patient Signature Source Code
    ID
    O可选(Optional)

    Code indicating how the patient or subscriber authorization signatures were obtained and how they are being retained by the provider

    Codes (5)
  • CLM11C024Related Causes InformationO可选(Optional)
    13621362136215626
    • CLM11011362Related-Causes Code
      ID
      M必须(Mandatory)

      Code identifying an accompanying cause of an illness, injury or an accident

      Codes (6)
    • CLM11021362Related-Causes Code
      ID
      O可选(Optional)

      Code identifying an accompanying cause of an illness, injury or an accident

      Codes (6)
    • CLM11031362Related-Causes Code
      ID
      O可选(Optional)

      Code identifying an accompanying cause of an illness, injury or an accident

      Codes (6)
    • CLM1104156State or Province Code
      ID
      O可选(Optional)
      Min 2 / Max 2

      Code (Standard State/Province) as defined by appropriate government agency

    • CLM110526Country Code
      ID
      O可选(Optional)
      Min 2 / Max 3

      Code identifying the country

  • CLM121366Special Program Code
    ID
    O可选(Optional)

    Code indicating the Special Program under which the services rendered to the patient were performed

    Codes (10)
  • CLM131073Yes/No Condition or Response Code
    ID
    O可选(Optional)

    Code indicating a Yes or No condition or response

    Codes (4)
  • CLM141338Level of Service Code
    ID
    O可选(Optional)

    Code specifying the level of service rendered

    Codes (17)
  • CLM151073Yes/No Condition or Response Code
    ID
    O可选(Optional)

    Code indicating a Yes or No condition or response

    Codes (4)
  • CLM161360Provider Agreement Code
    ID
    O可选(Optional)

    Code indicating the type of agreement under which the provider is submitting this claim

    Codes (7)
  • CLM171029Claim Status Code
    ID
    O可选(Optional)

    Code identifying the status of an entire claim as assigned by the payor, claim review organization or repricing organization

    Codes (41)
  • CLM181073Yes/No Condition or Response Code
    ID
    O可选(Optional)

    Code indicating a Yes or No condition or response

    Codes (4)
  • CLM191383Claim Submission Reason Code
    ID
    O可选(Optional)

    Code identifying reason for claim submission

    Codes (18)
  • CLM201514Delay Reason Code
    ID
    O可选(Optional)

    Code indicating the reason why a request was delayed

    Codes (14)
知行 EDI 规范查询平台™ 2023 - 3.1.18
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