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Patient Responsibility Payment Amount

CLM_LINE_BENE_PMT_AMT

AN AMOUNT IDENTIFYING THE PAYMENT MADE BY A BENEFICIARY FOR A DETAIL LINE OF SERVICE ON A CLAIM. NOTE: FOR PART D, THIS AMOUNT COUNT TOWARDS A BENEFICIARYS TRUE-OUT-OF-POCKET (TROOP) COST.

Field Metadata

FHIR Resource
ExplanationOfBenefit
FHIRPath 
ExplanationOfBenefit.item.adjudication.where(
  category.coding.where(
    system = 'http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication' and
      code = 'paidbypatient'
  ).exists() and
    category.coding.where(
      system = 'https://bluebutton.cms.gov/fhir/CodeSystem/Adjudication' and
        code = 'CLM_LINE_BENE_PMT_AMT'
    ).exists()
).amount.value
Coverage / Claim Type
  • Pharmacy
Source View
V2_MDCR_CLM_LINE
Source Column
CLM_LINE_BENE_PMT_AMT
Sources
  • DDPS
Profiles
  • Regular
  • CMS

Example 

10

Mappings

CCLF
  • CCLF7.CLM_LINE_BENE_PMT_AMT
CCW
  • PTNT_PAY_AMT

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