Claim Medicare Non Payment Reason Code

SAS Name
CLM_MDCR_NON_PMT_RSN_CD

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

Comments

This field was put on all institutional claim types but data did not start coming in on OP/HHA/Hospice until 4/1/02. Prior to 4/1/02, data only came in Inpatient/SNF claims.

Effective 4/1/02, 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. See table of code for the crosswalk.

NOTE3: 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

Effective 4/1/02, the Medicare nonpayment reason code was expanded to a 2-byte field. The NCH instituted a crosswalk from the 2-byte code to a 1-byte character code. Below are the character codes (found in NCH & NMUD). At some point, NMUD will carry the 2-byte code but NCH will continue to have the 1-byte character code.
Effective 4/1/02, the Medicare nonpayment reason code was expanded to a 2-byte field. The NCH instituted a crosswalk from the 2-byte code to a 1-byte character code. Below are the character codes (found in NCH & NMUD). At some point, NMUD will carry the 2-byte code but NCH will continue to have the 1-byte character code.
Code Code value
! MSP cost avoided - COB Contractor ('00' 2-byte code)
@ MSP cost avoided - BC/BS Voluntary Agreements ('12' 2-byte code)
# MSP cost avoided - Office of Personnel Management ('13' 2-byte code)
$ MSP cost avoided - Workman's Compensation (WC) Datamatch ('14' 2-byte code)
* MSP cost avoided - Workman's Compensation Insurer Voluntary Data Sharing Agreements (WC VDSA) ('15' 2-byte code) (eff. 4/2006)
( MSP cost avoided - Liability Insurer VDSA ('16' 2-byte code) (eff. 4/2006)
) MSP cost avoided - No-Fault Insurer VDSA ('17' 2-byte code) (eff. 4/2006)
+ MSP cost avoided - Pharmacy Benefit Manager Data Sharing Agreement ('18' 2-byte code) (eff. 4/2006)
< MSP cost avoided - MIR Group Health Plan ('21' 2-byte code) (eff. 1/2009)
> MSP cost avoided - MIR non-Group Health Plan ('22' 2-byte code) (eff. 1/2009)
% MSP cost avoided - Recovery Audit Contractor - California ('25' 2-byte code) (eff. 10/2005)
& MSP cost avoided - Recovery Audit Contractor - Florida ('26' 2-byte code) (eff. 10/2005)
! MSP cost avoided - COB Contractor ('00' 2-byte code)
@ MSP cost avoided - BC/BS Voluntary Agreements ('12' 2-byte code)
# MSP cost avoided - Office of Personnel Management ('13' 2-byte code)
$ MSP cost avoided - Workman's Compensation (WC) Datamatch ('14' 2-byte code)
* MSP cost avoided - Workman's Compensation Insurer Voluntary Data Sharing Agreements (WC VDSA) ('15' 2-byte code) (eff. 4/2006)
( MSP cost avoided - Liability Insurer VDSA ('16' 2-byte code) (eff. 4/2006)
) MSP cost avoided - No-Fault Insurer VDSA ('17' 2-byte code) (eff. 4/2006)
+ MSP cost avoided - Pharmacy Benefit Manager Data Sharing Agreement ('18' 2-byte code) (eff. 4/2006)
< MSP cost avoided - MIR Group Health Plan ('21' 2-byte code) (eff. 1/2009)
> MSP cost avoided - MIR non-Group Health Plan ('22' 2-byte code) (eff. 1/2009)
% MSP cost avoided - Recovery Audit Contractor - California ('25' 2-byte code) (eff. 10/2005)
& MSP cost avoided - Recovery Audit Contractor - Florida ('26' 2-byte code) (eff. 10/2005)