Blue Button 2.0 Implementation Guide
Defining URL:https://bluebutton.cms.gov/assets/ig/ValueSet-clm-mdcr-non-pmt-rsn-cd
Name:Claim Medicare Non Payment Reason Code
Definition:

The reason that no Medicare payment is made for services on an institutional claim. Source: https://bluebutton.cms.gov/resources/variables/clmmdcrnonpmtrsn_cd

Source ResourceXML / JSON / Turtle
This value set is used by:

Claim Medicare Non Payment Reason Code

The reason that no Medicare payment is made for services on an institutional claim. Source: https://bluebutton.cms.gov/resources/variables/clmmdcrnonpmtrsn_cd

This value set includes codes from the following code systems:

Expansion

This value set contains 47 concepts

Expansion based on https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-mdcr-non-pmt-rsn-cd version 1.1.1

All codes from system https://bluebutton.cms.gov/assets/ig/CodeSystem-clm-mdcr-non-pmt-rsn-cd

CodeDisplayDefinition
ACovered worker's compensation (Obsolete)Covered worker's compensation (Obsolete)
BBenefit exhaustedBenefit exhausted
CCustodial care – non-covered care (includes all 'beneficiary at fault' waiver cases) (Obsolete)Custodial care – non-covered care (includes all 'beneficiary at fault' waiver cases) (Obsolete)
EHMO out-of-plan services not emergency or urgently needed (Obsolete)HMO out-of-plan services not emergency or urgently needed (Obsolete)
FMSP cost avoid HMO Rate Cell (eff. 7/00)MSP cost avoid HMO Rate Cell (eff. 7/00)
GMSP cost avoided Litigation Settlement (eff. 7/00)MSP cost avoided Litigation Settlement (eff. 7/00)
HMSP cost avoided Employer Voluntary Reporting (eff. 7/00)MSP cost avoided Employer Voluntary Reporting (eff. 7/00)
JMSP cost avoid Insurer Voluntary Reporting (eff. 7/00)MSP cost avoid Insurer Voluntary Reporting (eff. 7/00)
KMSP cost avoid Initial Enrollment Questionnaire (eff. 7/00)MSP cost avoid Initial Enrollment Questionnaire (eff. 7/00)
NAll other reasons for non-paymentAll other reasons for non-payment
PPayment requestedPayment requested
QMSP cost avoided Voluntary Agreement (eff. 7/00)MSP cost avoided Voluntary Agreement (eff. 7/00)
RBenefits refused, or evidence not submittedBenefits refused, or evidence not submitted
TMSP cost avoided - IEQ contractor (eff. 9/76) (obsolete 6/30/00)MSP cost avoided - IEQ contractor (eff. 9/76) (obsolete 6/30/00)
UMSP cost avoided - HMO rate cell adjustment (eff. 9/76) (Obsolete 6/30/00)MSP cost avoided - HMO rate cell adjustment (eff. 9/76) (Obsolete 6/30/00)
VMSP cost avoided - litigation settlement (eff. 9/76) (Obsolete 6/30/00)MSP cost avoided - litigation settlement (eff. 9/76) (Obsolete 6/30/00)
WWorker's compensation (Obsolete)Worker's compensation (Obsolete)
XMSP cost avoided - genericMSP cost avoided - generic
YMSP cost avoided - IRS/SSA data match project (obsolete 6/30/00)MSP cost avoided - IRS/SSA data match project (obsolete 6/30/00)
ZZero reimbursement RAPs -- zero reimbursement made due to medical review intervention or where provider specific zero payment has been determined. (effective with HHPPS - 10/00)Zero reimbursement RAPs -- zero reimbursement made due to medical review intervention or where provider specific zero payment has been determined. (effective with HHPPS - 10/00)
00MSP cost avoided - COB ContractorMSP cost avoided - COB Contractor
12MSP cost avoided - BCBS Voluntary AgreementsMSP cost avoided - BCBS Voluntary Agreements
13MSP cost avoided - Office of Personnel ManagementMSP cost avoided - Office of Personnel Management
14MSP cost avoided - Workman's Compensation (WC) DatamatchMSP cost avoided - Workman's Compensation (WC) Datamatch
15MSP cost avoided - Workman's Compensation Insurer Voluntary Data Sharing Agreements (WC VDSA) (eff. 4/2006)MSP cost avoided - Workman's Compensation Insurer Voluntary Data Sharing Agreements (WC VDSA) (eff. 4/2006)
16MSP cost avoided - Liability Insurer VDSA (eff. 4/2006)MSP cost avoided - Liability Insurer VDSA (eff. 4/2006)
17MSP cost avoided - No-Fault Insurer VDSA (eff. 4/2006)MSP cost avoided - No-Fault Insurer VDSA (eff. 4/2006)
18MSP cost avoided - Pharmacy Benefit Manager Data Sharing Agreement (eff. 4/2006)MSP cost avoided - Pharmacy Benefit Manager Data Sharing Agreement (eff. 4/2006)
19SEE NOTE4: Coordination of Benefits Contractor 11119 (see CMS Change Request 7906 for identification of the contractor.)SEE NOTE4: Coordination of Benefits Contractor 11119 (see CMS Change Request 7906 for identification of the contractor.)
21MSP cost avoided - MIR Group Health Plan (eff. 1/2009)MSP cost avoided - MIR Group Health Plan (eff. 1/2009)
22MSP cost avoided - MIR non-Group Health Plan (eff. 1/2009)MSP cost avoided - MIR non-Group Health Plan (eff. 1/2009)
25MSP cost avoided - Recovery Audit Contractor - California (eff. 10/2005)MSP cost avoided - Recovery Audit Contractor - California (eff. 10/2005)
26MSP cost avoided - Recovery Audit Contractor - Florida (eff. 10/2005)MSP cost avoided - Recovery Audit Contractor - Florida (eff. 10/2005)
42SEE NOTE4: Coordination of Benefits Contractor 11142 (see CMS Change Request 7906 for identification of the contractor.)SEE NOTE4: Coordination of Benefits Contractor 11142 (see CMS Change Request 7906 for identification of the contractor.)
43SEE NOTE4: Coordination of Benefits Contractor 11143 (see CMS Change Request 7906 for identification of the contractor.) Effective 4/1/02, the Medicare nonpayment reason code was expanded to a 2-byte field. The NCH instituted a crosswalk from the 2-byte code to a 1-byte character code. Below are the character codes (found in NCH & NMUD). At some point, NMUD will carry the 2-byte code but NCH will continue to have the 1-byte character code.SEE NOTE4: Coordination of Benefits Contractor 11143 (see CMS Change Request 7906 for identification of the contractor.) Effective 4/1/02, the Medicare nonpayment reason code was expanded to a 2-byte field. The NCH instituted a crosswalk from the 2-byte code to a 1-byte character code. Below are the character codes (found in NCH & NMUD). At some point, NMUD will carry the 2-byte code but NCH will continue to have the 1-byte character code.
!MSP cost avoided - COB Contractor ('00' 2-byte code)MSP cost avoided - COB Contractor ('00' 2-byte code)
@MSP cost avoided - BC/BS Voluntary Agreements ('12' 2-byte code)MSP cost avoided - BC/BS Voluntary Agreements ('12' 2-byte code)
#MSP cost avoided - Office of Personnel Management ('13' 2-byte code)MSP cost avoided - Office of Personnel Management ('13' 2-byte code)
$MSP cost avoided - Workman's Compensation (WC) Datamatch ('14' 2-byte code)MSP cost avoided - Workman's Compensation (WC) Datamatch ('14' 2-byte code)
*MSP cost avoided - Workman's Compensation Insurer Voluntary Data Sharing Agreements (WC VDSA) ('15' 2-byte code) (eff. 4/2006)MSP cost avoided - Workman's Compensation Insurer Voluntary Data Sharing Agreements (WC VDSA) ('15' 2-byte code) (eff. 4/2006)
(MSP cost avoided - Liability Insurer VDSA ('16' 2-byte code) (eff. 4/2006)MSP cost avoided - Liability Insurer VDSA ('16' 2-byte code) (eff. 4/2006)
)MSP cost avoided - No-Fault Insurer VDSA ('17' 2-byte code) (eff. 4/2006)MSP cost avoided - No-Fault Insurer VDSA ('17' 2-byte code) (eff. 4/2006)
+MSP cost avoided - Pharmacy Benefit Manager Data Sharing Agreement ('18' 2-byte code) (eff. 4/2006)MSP cost avoided - Pharmacy Benefit Manager Data Sharing Agreement ('18' 2-byte code) (eff. 4/2006)
<MSP cost avoided - MIR Group Health Plan ('21' 2-byte code) (eff. 1/2009)MSP cost avoided - MIR Group Health Plan ('21' 2-byte code) (eff. 1/2009)
>MSP cost avoided - MIR non-Group Health Plan ('22' 2-byte code) (eff. 1/2009)MSP cost avoided - MIR non-Group Health Plan ('22' 2-byte code) (eff. 1/2009)
%MSP cost avoided - Recovery Audit Contractor - California ('25' 2-byte code) (eff. 10/2005)MSP cost avoided - Recovery Audit Contractor - California ('25' 2-byte code) (eff. 10/2005)
&MSP cost avoided - Recovery Audit Contractor - Florida ('26' 2-byte code) (eff. 10/2005)MSP cost avoided - Recovery Audit Contractor - Florida ('26' 2-byte code) (eff. 10/2005)