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Effective with Version H, the exemption number assigned by the Food and Drug Administration (FDA) to an investigational device after a manufacturer has been approved by FDA to conduct a clinical trial on that device. HCFA established a new policy of covering certain IDE's which was implemented in claims processing on 10/1/96 (which is NCH weekly process 10/4/96) for service dates beginning 10/1/95. IDE's are always associated with revenue center code '0624'.NOTE1: Prior to Version H a 'dummy' revenue center code '0624' trailer was created to store IDE's. The IDE number was housed in two fields: HCPCS code and HCPCS initial modifier; the second modifier contained the value 'ID'. There can be up to 7 distinct IDE numbers associated with an '0624' dummy trailer. During the Version H conversion IDE's were moved from the dummy '0624' trailer to this dedicated field. NOTE2: Effective with Version 'I', this field was renamed to eventually accommodate the National Drug Code (NDC) and the Universal Product Code (UPC). This field could contain either of these 3 fields (there would neverbe an instance where more than one would come in on a claim). The size of this field was expanded to X(24) to accommodate either of the new fields (under Version 'H' it was X(7). DATA ANAMOLY/LIMITATION: During an CWFMQA review an edit revealed the IDE was missing. The problem occurs in claim with an NCH weekly process dates of 6/9/00 through 9/8/00. During processing of the new format the program receives the IDE but then blanked out the data.
This field may contain one of three types of identifiers: the National Drug Code (NDC), the Universal Product Code (UPC), or the number assigned by the Food and Drug Administration (FDA) to an investigational device (IDE) after the manufacturer has approval to conduct a clinical trial.
The IDEs will have a revenue center code '0624'.
This field may contain one of three types of identifiers: the National Drug Code (NDC), the Universal Product Code (UPC), or the number assigned by the Food and Drug Administration (FDA) to an investigational device (IDE) after the manufacturer has approval to conduct a clinical trial.
The IDEs will have a revenue center code '0624'.
This field is used to identify the “net reimbursement amount” of what Medicare would have paid for the global budget service reflected at the line level, from a hospital participating in the particular model.
NDC numbers that are present in the revenue center trailers present on the claims that make up the stay.
NDC numbers that are present in the revenue center trailers present on the claims that make up the stay.
NDC numbers that are present in the revenue center trailers present on the claims that make up the stay.
NDC numbers that are present in the revenue center trailers present on the claims that make up the stay.
NDC numbers that are present in the revenue center trailers present on the claims that make up the stay.
NDC numbers that are present in the revenue center trailers present on the claims that make up the stay.
NDC numbers that are present in the revenue center trailers present on the claims that make up the stay.
NDC numbers that are present in the revenue center trailers present on the claims that make up the stay.
NDC numbers that are present in the revenue center trailers present on the claims that make up the stay.
NDC numbers that are present in the revenue center trailers present on the claims that make up the stay.
The quantity dispensed for the drug reflected on the revenue center line item.
Effective with Version 'J', the quantity dispensed for the drug reflected on the revenue center line item.
Effective with Version 'J', the quantity dispensed for the drug reflected on the revenue center line item.
The code used to indicate the unit of measurement for the drug that was administered.
Effective with Version 'J', the code used to indicate the unit of measurement for the drug that was administered.
The charge amount related to a revenue center code for services that are not covered by Medicare.
The code used to indicate that the provider was obligated to accept as full payment the amount received from the primary (or secondary) payer.
Effective with Version ‘L’ of the NCH layout, this line level field identifies the ordering physician’s National Provider Identifier (NPI).
The code used to identify those services that are packaged/bundled with another service.
Effective with Version I, the amount paid by the beneficiary to the provider for the line item service.
NOTE1: This field is populated for those claims that are required to process through Outpatient PPS Pricer. The type of bills (TOB) required to process through are: 12X, 13X, 14X (except Maryland providers, Indian Health Providers, hospitals located in American Samoa, Guam and Saipan and Critical Access Hospitals (CAH)); 76X; 75X and 34X if certain HCPCS are on the bill; and any outpatient type of bill with a condition code '07' and certain HCPCS. These claim types could have lines that are not required to price under OPPS rules so those lines would not have data in this field.
Additional exception: Virgin Island hospitals and hospitals that furnish only inpatient Part B services with dates of service 1/1/02 and forward.
ANAMOLY: For dates of service August 1, 2000 to present, the OPPS revenue center fields are being processed differently by FISS and APASS (standard systems). For more information on OPPS data problems for this time period see the Limitations Appendix. The following is how each system is handling this field:
FISS: populating correctly (sum of coinsurance and deductible)
APASS: not populating this field
Currently, the following FI numbers are under the APASS system and all other FI numbers are under FISS. See FI_NUM table of codes for all FI numbers.
52280 -- Mutual of Omaha (until 6/1/2003) 00430 -- Washington/Alaska (until 11/1/2003) 00310 -- North Carolina BC (until 12/1/2003) 00370 -- Rhode Island (until 2/1/2004) 00270 -- New Hampshire/Vermont (until 3/1/2004) 00181 -- Maine/Massachusetts (until 5/1/2004)
NOTE2: It has been discovered that this field may be populated with data on claims with dates of service prior to 7/00 (implementation of Claim Line Expansion OPPS/HHPPS). The original understanding of the new revenue center fields was that data would be populated on claims with dates of service 7/00 and forward. Data has been found in claims with dates of service prior to 7/00 because the Standard Systems have processed any claim coming in 7/00 and after, meeting the above criteria, through the Outpatient Code Editor (OCE) regardless of the dates of service.
The amount paid by the beneficiary to the provider for the line item service.
This field is the revenue-center Patient Initial Visit Add-On Amount. This field represents a base rate increase factor of 1.3516 for new patient initial preventive physical examination (IPPE) and annual wellness visit.
The amount paid to the beneficiary for the services reported on the line item.
The code used to identify how the service is priced for payment.
This field is made up of two pieces of data, 1st position being the status indicator and the 2nd position being the payment indicator.
The code used to identify if there was a deviation from the standard method of calculating payment amount.
Effective with Version 'I', the amount paid to the provider for the services reported on the line item.
NOTE1: This field is populated for those claims that are required to process through Outpatient PPS Pricer. The type of bills (TOB) required to process through are: 12X, 13X, 14X (except Maryland providers, Indian Health Providers, hospitals located in American Samoa, Guam and Saipan and Critical Access Hospitals (CAH)); 76X; 75X and 34X if certain HCPCS are on the bill; and any outpatient type of bill with a condition code '07' and certain HCPCS. These claim types could have lines that are not required to price under OPPS rules so those lines would not have data in this field.
Additional exception: Virgin Island hospitals and hospitals that furnish only inpatient Part B services with dates of service 1/1/02 and forward.
ANAMOLY: For dates of service August 1, 2000 to the present, the OPPS revenue center fields are being processed differently by FISS and APASS (standard systems). For more information on OPPS data problems for this time period see Limitations Appendix. The following is how each system handles this field:
FISS: populated correctly with provider payment amount
APASS: provider payment amount plus interest on 1st revenue center line (CMM will instruct APASS not to include interest)
Currently, the following FI numbers are under the APASS system and all other FI numbers are under FISS. See FI_NUM table of codes for all FI numbers. 52280 -- Mutual of Omaha (until 6/1/2003) 00430 -- Washington/Alaska (until 11/1/2003) 00310 -- North Carolina BC (until 12/1/2003) 00370 -- Rhode Island (until 2/1/2004) 00270 -- New Hampshire/Vermont (until 3/1/2004) 00181 -- Maine/Massachusetts (until 5/1/2004)
NOTE2: It has been discovered that this field may be populated with data on claims with dates of service prior to 7/00 (implementation of Claim Line Expansion OPPS/HHPPS). The original understanding of the new revenue center fields was that data would be populated on claims with dates of service 7/00 and forward. Data has been found in claims with dates of service prior to 7/00 because the Standard Systems have processed any claim coming in 7/00 and after, meeting the above criteria, through the Outpatient Code Editor (OCE) regardless of the dates of service.
Charges relating to unit cost associated with the revenue center code.
For all services subject to Outpatient prospective payment system (PPS or OPPS), the amount of coinsurance applicable to the line for a particular service (as indicated by the HCPCS code) for which the provider has elected to reduce the coinsurance amount.
Claim Remittance Advice Remark Code used to provide an additional explanation for an adjustment already described by a claim adjustment reason code (CARC) for a claim or claim line. It is also used to communicate information about remittance processing. This field is currently only populated for Direct Contracting (DC), Comprehensive Kidney Care Contracting (CKCC) and Kidney Care First (KCF) model claims.
This variable is the National Provider Identifier (NPI) for the physician who rendered the services on the revenue center record.
This variable is the unique physician identification number (UPIN) for the physician who rendered the services on the revenue center record.
NPIs replaced UPINs as the standard provider identifiers beginning in 2007. The UPIN is almost never populated after 2009.
This field at the line level to designate bypassing of the prior authorization processing for claims with a representative payee when an 'R' is present in the field.
This variable indicates how the service listed on the revenue center record was priced for payment purposes.
The revenue center status indicator code is most useful with outpatient hospital claims, where multiple methods may be used to determine the payment amount for the various revenue center records on the claim (for example, some lines may be bundled into an APC and paid under the outpatient PPS, while other lines may be paid under other fee schedules).
The field used to identify whether the claim line is subject to a therapy cap.
The field used to identify whether the claim line is subject to a therapy cap.
This line level field is used to represent the 15% reduction amount for physical therapy assistant (PTA) and occupational therapy assistant (OTA) services when modifiers CO or CQ are present.
This is the ending date of service for the line item
The total charges (covered and non-covered) for all accommodations and services (related to the revenue code) for a billing period before reduction for the deductible and coinsurance amounts and before an adjustment for the cost of services provided.
A quantitative measure (unit) of the number of times the service or procedure being reported was performed according to the revenue center/HCPCS code definition as described on an institutional claim or encounter record.
Depending on type of service, units are measured by number of covered days in a particular accommodation, pints of blood, emergency room visits, clinic visits, dialysis treatments (sessions or days), outpatient therapy visits, and outpatient clinical diagnostic laboratory tests.
A quantitative measure (unit) of the number of times the service or procedure being reported was performed according to the revenue center/HCPCS code definition as described on an institutional claim.
Depending on type of service, units are measured by number of covered days in a particular accommodation, pints of blood, emergency room visits, clinic visits, dialysis treatments (sessions or days), outpatient therapy visits, and outpatient clinical diagnostic laboratory tests
Effective with Version ‘L’ of the NCH layout, this line level field will be used to identify if the service (procedure code) was voluntary or required.
This code specifies whether the enrollee met the chronic condition algorithm criteria, considering both Medicare and Medicaid data, for having Rheumatoid - Osteo Arthritis.
This code specifies whether the enrollee met the chronic condition algorithm criteria, considering only Medicaid data, for having Rheumatoid - Osteoarthritis.
This code specifies whether the enrollee met the chronic condition algorithm criteria, considering only Medicare data, for having Rheumatoid - Osteoarthritis.
This variable indicates whether a beneficiary met the Chronic Condition Data Warehouse (CCW) criteria for rheumatoid arthritis/osteoarthritis as of the end of the calendar year.
This variable indicates whether a beneficiary met the Chronic Condition Data Warehouse (CCW) criteria for rheumatoid arthritis/osteoarthritis on July 1 of the specified reference period.