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| Data Element Name: Type of Bill | ||||
| Format-Length: A/N - 3 | Required For: AS, ED, IP | |||
X12 Loop |
Ref. Des. |
Data Element |
Code |
Description |
| 2300 | CLM05-1 | 1331 | Facility Type Code | |
| CLM05-2 | 1332 | A | Uniform Billing Claim Form Bill Type | |
| CLM05-3 | 1325 | Claim Frequency Code | ||
Effective Date: 1/1/94 |
Revision Date: September 2003 |
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Definition:
A three-digit numeric code which identifies the specific type of bill (inpatient, outpatient, adjustments, voids, etc.). The first digit represents Type of Facility, the second digit the Bill Classification, and the third digit the Frequency, which for SPARCS purposes is the transaction type. The first and second positions are separated from the third by the qualifier (CLM05-2, "A").
Codes and Values:
| 1. | All positions must be fully coded. |
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| 2. | Ambulatory Surgery Only: | |
| First Digit: | 1 = Hospital 7 = Clinic (free standing) 8 = Special facility (rural primary care facility ONLY) |
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| Second Digit: | 3 = Outpatient |
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| Third Digit: | 1 = New claim (new or add) 7 = Replacement of prior claim (change) 8 = Void/cancel of prior claim (delete) |
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| CODING EXAMPLES: | Hospital, OP, New claim: CLM*2745331203128112806*0.00***13:A:1~ Hospital, OP, Void/Cancel of prior claim: CLM*2745331203128112806*0.00***13:A:8~ Clinic, OP, New claim: CLM*2745331203128112806*0.00***73:A:1~ |
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Emergency Department Only: |
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| First Digit: | 1 = Hospital 8 = Special facility (rural primary care facility ONLY) |
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| Second Digit: | 3 = Outpatient |
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| Third Digit: | 1 = New claim (new or add) 7 = Replacement of prior claim (change) 8 = Void/cancel of prior claim (delete) |
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| CODING EXAMPLES: | Hospital, OP, New claim: CLM*2745331203128112806*0.00***13:A:1~ Hospital, OP, Replacement claim: CLM*2745331203128112806*0.00***13:A:7 |
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| Inpatient Only: | ||
| First Digit: | 1 = Hospital 8 = Special facility (rural primary care facility ONLY) |
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| Second Digit: | 1 = Inpatient (including medicare Part A) 2 = Inpatient (medicare Part B ONLY) 5 = Critical access hospital |
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| Third Digit: | 1 = New claim (new or add) 7 = Replacement of prior claim (change) 8 = Void/cancel of prior claim (delete) |
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| CODING EXAMPLES: | Hospital, IP (Medicare Part B Only), New claim: CLM*2745331203128112806*0.00***12:A:1~ Hospital, New claim: CLM*2745331203128112806*0.00***15:A:1~ Special facility, Critical Access Hosp, New claim: CLM*2745331203128112806*0.00***85:A:1~ |
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