Revenue Center Coinsurance/Wage Adjusted Coinsurance Amount

EFFECTIVE WITH NCH VERSION I, THE AMOUNT OF COINSURANCE APPLICABLE TO THE LINE ITEM SERVICE DEFINED BY THE REVENUE CENTER AND HCPCS CODES. FOR THOSE SERVICES SUBJECT TO OUTPATIENT PPS, THE APPLICABLE COINSURANCE IS WAGE ADJUSTED. NOTE1: THIS FIELD IS POPULATED FOR THOSE CLAIMS THAT ARE REQUIRED TO PROCESS THROUGH OUTPATIENT PPS PRICER. THE TYPE OF BILLS (TOB) REQUIRED TO PROCESS THROUGH ARE: 12X, 13X, 14X (EXCEPT MARYLAND PROVIDERS, INDIAN HEALTH PROVIDERS AND CRITICAL ACCESS HOSPITALS (CAH)); 76X; 75X AND 34X IF CERTAIN HCPCS ARE ON THE BILL; AND ANY OUTPATIENT TYPE OF BILL WITH A CONDITION CODE 07 AND CERTAIN HCPCS. THE ABOVE CLAIM TYPES COULD HAVE LINES THAT ARE NOT REQUIRED TO PRICE UNDER OPPS RULES SO THOSE LINES WOULD NOT HAVE DATA IN THIS FIELD. NOTE2: THIS FIELD WILL HAVE EITHER A ZERO (FOR SERVICES FOR WHICH COINSURANCE IS NOT APPLICABLE), A REGULAR COINSURANCE AMOUNT (CALCULATED ON EITHER CHARGES OR A FEE SCHEDULE) OR IF SUBJECT TO OP PPS THE NATIONAL COINSURANCE AMOUNT WILL BE WAGE ADJUSTED. THE WAGE ADJUSTED COINSURANCE IS BASED ON THE MSA WHERE THE PROVIDER IS LOCATED OR ASSIGNED AS A RESULT OF A RECLASSIFICATION. NOTE3: IT HAS BEEN DISCOVERED THAT THIS FIELD MAY BE POPULATED WITH DATA ON CLAIMS WITH DATES OF SERVICE PRIOR TO 7/00 (IMPLEMENTATION OF CLAIM LINE EXPANSION OPPS/HHPPS). THE ORIGINAL UNDERSTANDING OF THE NEW REVENUE CENTER FIELDS WAS THAT DATA WOULD BE POPULATED ON CLAIMS WITH DATES OF SERVICE 7/00 AND FORWARD. DATA HAS BEEN FOUND IN CLAIMS WITH DATES OF SERVICE PRIOR TO 7/00 BECAUSE THE STANDARD SYSTEMS HAVE PROCESSED ANY CLAIM COMING IN 7/00 AND AFTER, MEETING THE ABOVE CRITERIA, THROUGH THE OUTPATIENT CODE EDITOR (OCE) REGARDLESS OF THE DATES OF SERVICE [NCH]

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