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Back  RFI # 1019: Negative Amounts in CLP05

Formal vs. Informal Help Informal Formal

Submitter

Jessica Chase

Description

Can the CLP05 be negative? Occassionally our business generates a negative Patient Responsibility reported in the CAS when COB is involved. (Provider is non-contracted with Primary, we are sending our contractual obligation, Primary paid more than we allow). Can those amounts be summed and reported as a negative amount in the CLP05?

Submitter Assigned Keywords

CLP05

Response

This issue is explicitly addressed in guide 005010X221. The situational rule on CLP05 reads "Required when the patient’s responsibility is greater than zero. If not required by this implementation guide, do not send."

As a result, sending a CLP05 value that is zero or negative is explicitly prohibited.
Submission 4/7/2010
Status Date 4/27/2010
Status F - Final
Primary References
Document 005010X221
Section2.4
Page125
Set ID835
Table2
Loop2100
Segment Position0100
Segment IDCLP
Element Position05