Updated research request forms and data security approval requirement effective 4/24/23
The claim level maximum amount determined by the payer as being 'allowable' under the provisions of the contract prior to the determination of actual payment.
Not available for managed care claims. CMS has required redaction of some payment fields for managed care claims due to the proprietary and confidential nature of this information. The managed care records are identified as those where the claim type code (CLM_TYPE_CD) = 3, C or W.
SOURCE: T-MSIS Analytic File (TAF) Claims
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