Claim Pricer Return Code

SAS Name
CLM_PRCR_RTRN_CD

The code used to identify various prospective payment system (PPS) payment adjustment types. This code identifies the payment return code or the error return code for every claim type calculated by the PRICER tool.

Comments

The payment return code identifies the type of payment calculated by the PRICER software.

Source: NCH

 

End Stage Renal Disease (ESRD) Pricer Return Codes
End Stage Renal Disease (ESRD) Pricer Return Codes
End Stage Renal Disease (ESRD) Pricer Return Codes
End Stage Renal Disease (ESRD) Pricer Return Codes
End Stage Renal Disease (ESRD) Pricer Return Codes
End Stage Renal Disease (ESRD) Pricer Return Codes
End Stage Renal Disease (ESRD) Pricer Return Codes
End Stage Renal Disease (ESRD) Pricer Return Codes
Code Code value
00 ESRD PPS payment calculated
01 ESRD facility rate > zero
22 For ESRD Pricer, it means PPS w/acute comorbid, training.
26 For ESRD Pricer, it means PPS w/chronic comorbid, low volume, training.
31 ESRD Pricer means PPS w/low BMI.
32 ESRD Pricer means PPS w/low volume, onset.
33 For ESRD Pricer, it means PPS w/outlier, training.
50 ESRD facility rate not numeric
52 Provider type not = '40' or '41'
53 Special payment indicator not = '1' or blank
54 Date of birth not numeric or = zero
55 Patient weight not numeric or = zero
56 Patient height not numeric or = zero
57 Revenue center code not in range
58 Condition code not = '73' or '74' or blank
60 MSA wage adjusted rate record not found
98 Claim through date before 4/1/2005 or not numeric
00 ESRD PPS payment calculated
01 ESRD facility rate > zero
22 For ESRD Pricer, it means PPS w/acute comorbid, training.
26 For ESRD Pricer, it means PPS w/chronic comorbid, low volume, training.
31 ESRD Pricer means PPS w/low BMI.
32 ESRD Pricer means PPS w/low volume, onset.
33 For ESRD Pricer, it means PPS w/outlier, training.
50 ESRD facility rate not numeric
52 Provider type not = '40' or '41'
53 Special payment indicator not = '1' or blank
54 Date of birth not numeric or = zero
55 Patient weight not numeric or = zero
56 Patient height not numeric or = zero
57 Revenue center code not in range
58 Condition code not = '73' or '74' or blank
60 MSA wage adjusted rate record not found
98 Claim through date before 4/1/2005 or not numeric
00 ESRD PPS payment calculated
01 ESRD facility rate > zero
22 For ESRD Pricer, it means PPS w/acute comorbid, training.
26 For ESRD Pricer, it means PPS w/chronic comorbid, low volume, training.
31 ESRD Pricer means PPS w/low BMI.
32 ESRD Pricer means PPS w/low volume, onset.
33 For ESRD Pricer, it means PPS w/outlier, training.
50 ESRD facility rate not numeric
52 Provider type not = '40' or '41'
53 Special payment indicator not = '1' or blank
54 Date of birth not numeric or = zero
55 Patient weight not numeric or = zero
56 Patient height not numeric or = zero
57 Revenue center code not in range
58 Condition code not = '73' or '74' or blank
60 MSA wage adjusted rate record not found
98 Claim through date before 4/1/2005 or not numeric
00 ESRD PPS payment calculated
01 ESRD facility rate > zero
22 For ESRD Pricer, it means PPS w/acute comorbid, training.
26 For ESRD Pricer, it means PPS w/chronic comorbid, low volume, training.
31 ESRD Pricer means PPS w/low BMI.
32 ESRD Pricer means PPS w/low volume, onset.
33 For ESRD Pricer, it means PPS w/outlier, training.
50 ESRD facility rate not numeric
52 Provider type not = '40' or '41'
53 Special payment indicator not = '1' or blank
54 Date of birth not numeric or = zero
55 Patient weight not numeric or = zero
56 Patient height not numeric or = zero
57 Revenue center code not in range
58 Condition code not = '73' or '74' or blank
60 MSA wage adjusted rate record not found
98 Claim through date before 4/1/2005 or not numeric
00 ESRD PPS payment calculated
01 ESRD facility rate > zero
22 For ESRD Pricer, it means PPS w/acute comorbid, training.
26 For ESRD Pricer, it means PPS w/chronic comorbid, low volume, training.
31 ESRD Pricer means PPS w/low BMI.
32 ESRD Pricer means PPS w/low volume, onset.
33 For ESRD Pricer, it means PPS w/outlier, training.
50 ESRD facility rate not numeric
52 Provider type not = '40' or '41'
53 Special payment indicator not = '1' or blank
54 Date of birth not numeric or = zero
55 Patient weight not numeric or = zero
56 Patient height not numeric or = zero
57 Revenue center code not in range
58 Condition code not = '73' or '74' or blank
60 MSA wage adjusted rate record not found
98 Claim through date before 4/1/2005 or not numeric
00 ESRD PPS payment calculated
01 ESRD facility rate > zero
22 For ESRD Pricer, it means PPS w/acute comorbid, training.
26 For ESRD Pricer, it means PPS w/chronic comorbid, low volume, training.
31 ESRD Pricer means PPS w/low BMI.
32 ESRD Pricer means PPS w/low volume, onset.
33 For ESRD Pricer, it means PPS w/outlier, training.
50 ESRD facility rate not numeric
52 Provider type not = '40' or '41'
53 Special payment indicator not = '1' or blank
54 Date of birth not numeric or = zero
55 Patient weight not numeric or = zero
56 Patient height not numeric or = zero
57 Revenue center code not in range
58 Condition code not = '73' or '74' or blank