Claim Next Generation (NG) Accountable Care Organization (ACO) Indicator Code - Capitation

SAS Name

The field identifies the claims that qualify for specific claims processing edits related to benefit enhancement through the Next Generation (NG) Accountable Care Organization (ACO).


Source: NCH

Code Code value
0 Base record (no enhancements)
1 Population Based Payments (PBP)
2 Telehealth
3 Post Discharge Home Health Visits
4 3-Day SNF Waiver
5 Capitation
6 CEC Telehealth
7 Care Management Home Visits
8 Primary Care Capitation (PCC)
9 Home Health Benefit Enhancement — eff. 4/2021
B Concurrent Care for Beneficiaries that Elect the Medicare Hospice Benefit — eff. 4/2021
C Kidney Disease Education (KDE) — eff. 4/2021
D Seriously Ill Population (SIP)
E Flat Visit Fee (FVF)
F Quarterly Capitation Payment (QCP) — eff. 4/2021
G Performance Based Adjustment (PBA) — eff. 7/2022