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Back  RFI # 681: ERA - CLP05 copay

Formal vs. Informal Help Informal Formal

Submitter

Ellen Falbowski

Description

Sometimes people will say they don't think the CLP05 should be populated for, say, co-pay, because there is an assumption that the patient paid their co-pay at the time of service and there is a concern that the provider might see a non-zero CLP05 value and bill the patient for a pat resp that had already been paid. Does the WG3 have an opinion on this?

Submitter Assigned Keywords

ERA CLP05 copay

Response

This issue is explicitly addressed in guide 004010X091. The note on CLP05 states "This amount must be entered if it is greater than zero." Since the co-pay is the patient's responsibility, it must be entered. That entry in CLP05 makes no statement about whether the patient has or has not already met this responsibility. That issue is external to the 835.
Submission 8/27/2008
Status Date 9/18/2008
Status F - Final
Primary References
Document 004010X091A1
SectionDETAIL
Page91
Set ID835
Table2
Loop2100
Segment Position010
Segment IDCLP
Element Position05
Industry NamePatient Responsibility Amount