NCH Claim Payment Amount to Beneficiary | ResDAC

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This variable is contained in the following files:

SAS Name

NCH_CLM_BENE_PMT_AMT

The total payments made to the beneficiary for this claim (sum of all line-level payments to beneficiary, variable called LINE_BENE_PMT_AMT).

Values: XXX.XX

Source: NCH QA Process

Comments

This variable is populated if, for example, a beneficiary pays for a service that should have been Medicare-covered.

The beneficiary can be refunded the payment.

Costs to that beneficiaries are liable for are described in detail on the Medicare.gov website. There is a CMS publication called "Your Medicare Benefits," which explains the deductibles and coinsurance amounts.

Medicare payments are described in detail in a series of Medicare Payment Advisory Commission (MedPAC) documents called “Payment Basics”.

Also, in the Medicare Learning Network (MLN) “Payment System Fact Sheet Series”.