Claim Non Payment Reason Code
CLM_MDCR_NPMT_RSN_CD THE REASON THAT NO MEDICARE PAYMENT IS MADE FOR SERVICES ON AN INSTITUTIONAL CLAIM. NOTE: EFFECTIVE WITH NCH VERSION I, THIS FIELD WAS PUT ON ALL INSTITUTIONAL CLAIM TYPES. NOTE1: THIS FIELD WAS PUT ON ALL INSTITUTIONAL CLAIM TYPES BUT DATA DID NOT START COMING IN ON OP/HHA/HOSPICE UNTIL 4/1/02. PRIOR TO 4/1/02, DATA ONLY CAME IN INPATIENT/SNF CLAIMS. NOTE2: EFFECTIVE 4/1/02, THIS FIELD WAS ALSO EXPANDED TO TWO BYTES TO ACCOMMODATE NEW VALUES. THE NCH NEARLINE FILE DID NOT EXPAND THE CURRENT 1-BYTE FIELD BUT INSTITUTED A CROSSWALK OF THE 2-BYTE FIELD TO THE 1-BYTE CHARACTER VALUE. SEE TABLE OF CODE FOR THE CROSSWALK. [NCH]
Field Metadata
- FHIR Resource
- ExplanationOfBenefit
- FHIRPath
- ExplanationOfBenefit.supportingInfo.where(category.coding.where(system = 'https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information').exists() andcategory.coding.where(code = 'CLM_MDCR_NPMT_RSN_CD').exists()).code.coding.code
- Coverage / Claim Type
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- HHA
- Hospice
- Inpatient
- Outpatient
- SNF
- Source View
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V2_MDCR_CLM_INSTNL - Source Column
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CLM_MDCR_NPMT_RSN_CD - Reference Table
- https://bluebutton.cms.gov/fhir/CodeSystem/CLM-MDCR-NPMT-RSN-CD
- Sources
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- FISS
- NCH
- Profiles
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- CMS
Example
PMappings
- CCLF
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CCLF1.CLM_MDCR_NPMT_RSN_CD
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- CCW
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CLM_MDCR_NON_PMT_RSN_CD
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