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The Basics of CLPs
April 18, 2022
Claim Level Payments (CLPs) provide information regarding the various claims on a single electronic remittance advice (ERA). A single CLP represents a billing claim for one or many services from a billing provider for a single patient. There can be one or many claims on a single remittance. Whereas PLBs are not a necessary component of a remittance, CLPs are required in the 835. The electronic funds transfer (EFT) amount, all claim amounts, and any provider level adjustment amounts that may be present on the remittance must balance out.
The following example illustrates how a CLP would appear in an 835 file:
Fawkes Health’s CAMS application aids in the remittance process by converting the 835 into a human readable format, making each patient’s claim easier to identify. Each CLP line in the CAMS remittance workflow includes the PCN associated with the patient as well as the patient’s name, the start date of the claim, the total charge amount, and the payment amount. The CAMS remittance process is automated to send these claims to the appropriate patient account system based on the individual PCN, even if the CLPs on the remittance go to different systems.
The Claim Status Code indicates the status of the claim as it is assigned by the payer. There are several Claim Status Codes that could appear in the CLP segment on a remittance. Below is a table which references some examples of these.
| Claim Status Code | Description |
|---|---|
| 1 | Primary - Current Payer |
| 2 | Secondary - Current Payer |
| 3 | Tertiary - Current Payer |
| 4 | Denied - Claim was not forwarded to another payer |
| 19 | Primary - Forwarded to additional Payer(s) |
| 20 | Secondary - Forwarded to additional Payer(s) |
| 21 | Tertiary - Forwarded to additional Payer(s) |
| 22 | Reversal |
| 23 | Not the Payers Claim - Forwarded to additional Payer(s) |
In addition to the Claim Status Code, the Filing Indicator Code identifies what type of claim is represented on the individual CLP line. The below table shows some examples of these. This is not an exhaustive list.
| Filing Indicator Code | Description |
|---|---|
| 12 | Preferred Provider Organization (PPO) |
| 13 | Point of Service (POS) |
| 16 | Health Maintenance Organization (HMO) Medicare Risk |
| AM | Automobile Medical |
| DS | Disability |
| LM | Liability Medical |
| MA | Medicare Part A |
| MB | Medicare Part B |
| MC | Medicaid |
| OF | Other Federal Program |
Information was sourced from: Centers for Medicare & Medicaid Services