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Claim ACO Care Management HCBS Switch

CLM_ACO_CARE_MGMT_HCBS_SW

AN INTEGRATED DATA REPOSITORY (IDR) DERIVED INDICATOR BASED ON THE CLAIM LINE NEXT GENERATION (NG) ACCOUNTABLE CARE ORGANIZATION (ACO) INDICATOR CODE FROM CWF (COMMON WORKING FILE), WHICH IDENTIFIES THE BENEFIT ENHANCEMENT INDICATOR THAT IDENTIFIES CLAIMS THAT QUALIFY FOR SPECIFIC CLAIM PROCESSING EDITS. VALID VALUES: Y = IF ANY OF THE FIVE CLAIM LINE NG ACO INDICATOR CODES CONTAINS ѶҠ(CARE MANAGEMENT HOME VISITS). N = IF Ѷ4ҠOR Ѹ9ҠIS FOUND IN ANY OF THE CLM_DCMTN.CLM_DEMO_1ST_NUM THROUGH CLM_DCMTN.CLM_DEMO_5TH_NUM COLUMNS AND NONE OF THE FIVE NG ACO INDICATOR CODES CONTAINS ѶҮ NULL = DEFAULT

Field Metadata

FHIR Resource
ExplanationOfBenefit
FHIRPath 
ExplanationOfBenefit.supportingInfo.where(
  category.coding.where(
    system = 'https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information'
  ).exists() and
    category.coding.where(
      code = 'CLM_ACO_CARE_MGMT_HCBS_SW'
    ).exists()
).value
Coverage / Claim Type
  • HHA
  • Hospice
  • Inpatient
  • Outpatient
  • SNF
Source View
V2_MDCR_CLM_DCMTN
Source Column
CLM_ACO_CARE_MGMT_HCBS_SW
Sources
  • NCH
Profiles
  • CMS

Notes

This field is deprecated in shared systems data. Its value can be derived as Y if any CLM_BNFT_ENHNCMT_X_CD = 7, else N.

Mappings

CCLF
  • CCLFA.CLM_NGACO_CMG_WVR_SW

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