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Claim PPS Old Capital Hold Harmless Amount

CLM_MDCR_IP_PPS_CPTL_HRMLS_AMT

EFFECTIVE 3/2/92, THIS AMOUNT IS THE HOLD HARMLESS AMOUNT PAYABLE FOR OLD CAPITAL AS COMPUTED BY PRICER FOR PROVIDERS WITH A PAYMENT CODE EQUAL TO A. THE HOLD HARMLESS AMOUNT-OLD CAPITAL IS 100 PERCENT OF THE REASONABLE COSTS OF OLD CAPITAL FOR SOLE COMMUNITY SOLE COMMUNITY HOSPITALS, OR 85 PERCENT OF THE REASONABLE COSTS ASSOCIATED WITH OLD CAPITAL FOR ALL OTHER HOSPITALS, PLUS A PAYMENT FOR NEW CAPITAL. [NCH]

Field Metadata

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

Example 

13.31

Mappings

CCW
  • CLM_PPS_OLD_CPTL_HLD_HRMLS_AMT

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