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Back  RFI # 504: CLP01 not identical to claim

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Submitter

Janice Cunningham

Description

The value being reported in CLP01 is not being reported identical to the value reported as the patient control number on the claim. The payer is stating that since the claims are submitted on paper the value in CLP01 does not have to be identical to the patient control number on the paper claim because the X12 IG only stated CLP01 of the ANSI X12 837.

Please clarify the intention of the X12 Workgroup. Should it be identical the claim regardless of how the claim is submitted?

Submitter Assigned Keywords

CLP01 not identical to value submitted on claim

Response

This issue is explicitly addressed in guide 004010X091. The note on CLP01 states "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)." The reference to the 837 states "if applicable" and does not represent a statement excluding other formats. The "if applicable" phrase is only an example and does not preclude the full statement from applying to all formats of claims.

CLP01 is the unique identifier that the provider assigns to the patient's record/claim. Without this value being returned in CLP01 as identified in the patient account field of the 1500, UB04 (92/82), ADA claim forms, CLM01 of the 837, NCPDP, or other such claim format, the financial savings that can be appreciated with the 835 is lost by both parties.
Submission 1/4/2007
Status Date 1/6/2007
Status F - Final
Primary References
Document 004010X091A1
Section835
Page89
Set IDCLP01
Loop2100
Segment PositionCLP
Element Position01