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Data Element Name:  Type of Bill
Format-Length:  A/N - 3 Required For:  AS, ED, IP
Effective Date:  1/1/94 Revision Date:  September 2003

National Standard Mapping:

Electronic - 837I

X12 Loop

Ref. Des.

Data Element

Code

Description
Version 4050R 2300 CLM05-1 1331 Facility Type Code
CLM05-2 1332 A Uniform Billing Claim Form Bill Type
CLM05-3 1325 Claim Frequency Code

Paper Form Locator Code Qualifier
Institutional - UB-04 04 N/A

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.

2. Ambulatory Surgery Only:
First Digit: 1 = Hospital
7 = Clinic (free standing)
8 = Special facility (rural primary care facility ONLY)

Second Digit: 3 = Outpatient

Third Digit: 1 = New claim (new or add)
7 = Replacement of prior claim (change)
8 = Void/cancel of prior claim (delete)

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~

Emergency Department Only:
First Digit: 1 = Hospital
8 = Special facility (rural primary care facility ONLY)

Second Digit: 3 = Outpatient

Third Digit: 1 = New claim (new or add)
7 = Replacement of prior claim (change)
8 = Void/cancel of prior claim (delete)

CODING EXAMPLES: Hospital, OP, New claim:    CLM*2745331203128112806*0.00***13:A:1~
Hospital, OP, Replacement claim:    CLM*2745331203128112806*0.00***13:A:7

Inpatient Only:
First Digit: 1 = Hospital
8 = Special facility (rural primary care facility ONLY)

Second Digit: 1 = Inpatient (including medicare Part A)
2 = Inpatient (medicare Part B ONLY)
5 = Critical access hospital

Third Digit: 1 = New claim (new or add)
7 = Replacement of prior claim (change)
8 = Void/cancel of prior claim (delete)

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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