Claim Model Reimbursement Amount

SAS Name

This field is used to identify the “net reimbursement amount” of what Medicare would have paid for global budget services from a hospital participating in the particular model. If the claim only includes global services the reimbursement amount (CLM_PMT_AMT) will reflect $0. If the claim includes global and non-global services the reimbursement amount will reflect the amount Medicare actually paid for the non-global services.


Source: NCH

This field is new in January 2020. This field only applies to Part A claims. This model reimbursement amount applies to the Pennsylvania Rural Health Model (PARHM) (CR11355). A demo code (variable called DEMO_ID_NUM) will be assigned for future models. CLM_RLT_COND_CD = M6 (on the Occurrence Code File) and CLM_VAL_CD = Q4 (on the Value Code File) have been created to identify the PARH model.