Claim Next Generation (NG) Accountable Care Organization (ACO) Indicator Code - Population-Based Payment (PBP)

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