Claim Medicare Non-Payment Reason Code

SAS Name

The reason that no Medicare payment is made for services on an institutional claim. 


This field was put on all institutional claim types, but data did not start coming in on OP/HHA/Hospice until 4/1/2002. Prior to 4/1/2002, data only came in Inpatient/SNF claims.

Effective 4/1/2002, this field was also expanded to two bytes to accommodate new values. The NCH Nearline file did not expand the current 1-byte field but instituted a crosswalk of the 2-byte field to the 1-byte character value. Reference table of code for the crosswalk.

NOTE: Effective with Version ‘J,’ the field has been expanded on the NCH claim to 2 bytes. With this expansion the NCH will no longer use the character values to represent the official two-byte values being sent in by NCH since 4/2002.

During the Version 'J' conversion, all character values were converted to the two-byte values.

Source: NCH