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Back  RFI # 829: CLP02 interpretation for payer

Formal vs. Informal Help Informal Formal

Submitter

Denise Page

Description

Could you tell me how you would interpret the CLP02 in the 835 . It is the “claim status code”, and we use it for how we processed the claim, whether we processed it as a primary or secondary or other. Not how the subscribers policies might be . We have a provider telling us that we are populating this field incorrect. The provider beleive that we should be populating the CLP02, as they have the patients policies setup.

Could you give me what your interpretations would be for this data element.

Submitter Assigned Keywords

CLP02 in HIPAA 835

Response

This issue is explicitly addressed in guide 004010X091. The purpose for element CLP02 states "Code identifying the status of an entire claim as assigned by the payor, claim review organization or repricing organization". Therefore, this element represents how the Payer handled the claim (processed as primary, secondary, etc), and not how the provider has the claim setup in their system.
Submission 8/6/2009
Status Date 9/14/2009
Status F - Final
Primary References
Document 004010X091A1
Section835
Page89
Set ID2100
Loop2100