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The code that indicates a condition relating to an institutional claim or encounter record that may affect payer processing.
The code that indicates a condition relating to an institutional claim that may affect payer processing.
The sequence number of the claim related condition code (variable called CLM_RLT_COND_CD).
The code that identifies a significant event relating to an institutional claim or encounter record that may affect payer processing.
These codes are associated with a specific date (the claim related occurrence date).
The code that identifies a significant event relating to an institutional claim that may affect payer processing.
These codes are associated with a specific date (the claim related occurrence date).
The sequence number of the claim related occurrence code (variable called CLM_RLT_OCRNC_CD).
The date associated with a significant event related to an institutional claim or encounter record that may affect payer processing.
The date for the event that appears in the claim related occurrence code field.
The date associated with a significant event related to an institutional claim that may affect payer processing.
The date for the event that appears in the claim related occurrence code field.
The sequence number of the related span code (variable called CLM_SPAN_CD).
The sequence number of the related claim value code (variable called CLM_VAL_CD).
This variable is the National Provider Identifier (NPI) for the physician who rendered the services.
NPIs replaced UPINs as the standard provider identifiers beginning in 2007. The UPIN is almost never populated after 2009.
The code used to identify the CMS specilty code of the rendering physician/practitioner.
Claim Representative Payee (RP) Indicator Code
Claim Residual Payment Indicator Code
The type of service provided to the beneficiary.
The type of service provided to the beneficiary.
ZIP code where service was provided, as indicated on the claim.
The National Provider Identifier (NPI) of the location where the services were provided.
Under the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS), the payment amount based on the MS-LTC-DRG payment with short stay outlier (SSO) adjustment.
Under the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS), the payment amount based on estimated cost of the case.
Under the Long Term Care Hospital (LTCH) prospective payment system (PPS), the payment amount based on the inpatient prospective payment system (IPPS) comparable amount. This amount does not include any applicable outlier payment amount.
Under the Long Term Care Hospital (LTCH) Prospective Payment System (PPS), the payment amount based on the Inpatient Prospective Payment (IPPS) comparable amount. This amount does not include any applicable outlier payment amount
The code indicating the source of the referral for the admission or visit.
The code indicating the source of the referral for the admission or visit.
The last day on the billing statement covering services rendered to the beneficiary (a.k.a. 'Statement Covers Thru Date').
The last day on the billing statement covering services rendered to the beneficiary (a.k.a 'Statement Covers Thru Date').
The total charges for all services included on the institutional claim.
This field is redundant with revenue center code 0001/total charges.
The total amount that is payable for capital for the prospective payment system (PPS) claim.
This is the sum of the capital hospital specific portion, federal specific portion, outlier portion, disproportionate share portion, indirect medical education portion, exception payments, and hold harmless payments.
The number assigned by the medical reviewer and reported by the provider to identify the medical review (treatment authorization) action taken after review of the beneficiary's case. It designates that treatment covered by the bill has been authorized by the payer.
The type of claim that was submitted. There are different claim types for each major category of health care provider.
A code indicating what kind of payment is covered in this claim
This field identifies the payment for disproportionate share hospitals (DSH). It represents the uncompensated care amount of the payment.
The amount related to the condition identified in the claim value code (variable called CLM_VAL_CD) which was used by the intermediary to process the institutional claim.
The code indicating a monetary condition which was used on an institutional claim.
The code indicating a monetary condition which was used by the intermediary to process an institutional claim.
The associated monetary value is in the claim value amount field (CLM_VAL_AMT).
This field is the code used to identify a reason a hospital is excluded from the Hospital Value Based Purchasing (HVBP) program.
This field represents the Hospital Value Based Purchasing (HVBP) Amount.
This could be an additional payment on the claim or a reduction, depending on the hospital's performance score.
Under the Hospital Value Based Purchasing (HVBP) program, an adjustment is made to the base operating DRG amount for certain Inpatient Prospective Payment System (IPPS) hospitals - based on their Total Performance Score (TPS).
A beneficiary may be both voluntarily aligned to the ACO and assigned through claims-based assignment and may have a flag designating they were assigned through both methods.
The charge amount (rounded to whole dollars) for clinic visits (e.g., visits to chronic pain or dental centers or to clinics providing psychiatric, OB-GYN, pediatric services) related to the beneficiary's stay.
CLINICAL FORMULATION ID REPRESENTS THE CLINICAL FORMULATION, WHICH IS THE COMBINATION OF ACTIVE INGREDIENTS, DOSAGE FORM AND STRENGTH. [P.1597]. A GCN_SEQNO CAN BE LINKED TO MANY PACKAGED DRUG PRODUCTS, BUT A PACKAGED DRUG PRODUCT CAN HAVE ONLY ONE GCN_SEQNO.NOTE: IN MAX 2007, THIS VARIABLE WAS ADDED TO THE FILE.
The identification number assigned to the clinical laboratory providing services for the line item on the carrier claim (non-DMERC).
The number used to identify all items and line item services provided to a beneficiary during their participation in a clinical trial.
This code is used to identify that the care improvement model 2 is being used for payments.
The data in this column contains the calculated Medicare Set Code used for the Part A RUG.
The data in this column contains the calculated Medicare non-therapy Set Code.
The data in this column contains the calculated state Medicaid RUG Set Code.
The data in this column contains the second calculated state Medicaid RUG Set Code.
The data in this column contains the calculated Medicare CMI value returned for the Part A RUG.
The data in this column contains the calculated Medicare non-therapy CMI value.