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Outpatient Beneficiary Payment Amount

CLM_MDCR_INSTNL_BENE_PD_AMT

EFFECTIVE WITH NCH VERSION H, THE AMOUNT PAID, FROM THE MEDICARE TRUST FUND, TO THE BENEFICIARY FOR THE SERVICES REPORTED ON THE OUTPATIENT CLAIM. NOTE: BEGINNING WITH NCH WEEKLY PROCESS DATE 10/3/97 THIS FIELD WAS POPULATED WITH DATA. CLAIMS PROCESSED PRIOR TO 10/3/97 WILL CONTAIN ZEROES IN THIS FIELD. [NCH]

Field Metadata

FHIR Resource
ExplanationOfBenefit
FHIRPath 
ExplanationOfBenefit.adjudication.where(
  category.coding.where(
    system = 'https://bluebutton.cms.gov/fhir/CodeSystem/Adjudication' and
      code = 'CLM_BENE_PD_AMT'
  ).exists()
).amount.value
Coverage / Claim Type
  • Outpatient
Source View
V2_MDCR_CLM_INSTNL
Source Column
CLM_MDCR_INSTNL_BENE_PD_AMT
Sources
  • NCH
Profiles
  • Regular
  • CMS

Notes

The processing-equivalent field is CLM_BENE_PD_AMT for institutional claims.

Mappings

CCW
  • CLM_OP_BENE_PMT_AMT

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