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Claim Line ACO Care Management HCBS Switch

CLM_LINE_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 claims that qualify for specific claim processing edits. Valid values: Y = If any of the five claim line NG ACO indicator codes contains care management home visits. N = If applicable codes are found and none of the five NG ACO indicator codes contains care management home visits. 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_LINE_ACO_CARE_MGMT_HCBS_SW'
    ).exists()
).value
Coverage / Claim Type
  • Carrier
Source View
V2_MDCR_CLM_LINE_DCMTN
Source Column
CLM_LINE_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_LINE_BNFT_ENHNCMT_X_CD = 7, else N.

Mappings

CCLF
  • CCLFB.CLM_NGACO_CMG_WVR_SW

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