Skip to main content

Official websites use .gov
A.gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS
Alock () or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.

Claim NGACO Capitation Switch

CLM_NGACO_CPTATN_SW

An Integrated Data Repository (IDR) derived indicator based on the claim Next Generation (NG) Accountable Care Organization (ACO) indicator code from CWF (Common Working File), which identifies claims that qualify for specific claim processing edits. Valid values: Y = If any of the five claim NG ACO indicator codes contains capitation. N = If applicable codes are found and none of the five NG ACO indicator codes contains capitation. Null = Default

Field Metadata

FHIR Resource
ExplanationOfBenefit
FHIRPath
ExplanationOfBenefit.supportingInfo.where(
  category.coding.where(
    system = 'https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information'
  ).exists() and
    category.coding.where(code = 'CLM_NGACO_CPTATN_SW').exists()
).value
Coverage / Claim Type
  • HHA
  • Hospice
  • Inpatient
  • Outpatient
  • SNF
Source View
V2_MDCR_CLM_DCMTN
Source Column
CLM_NGACO_CPTATN_SW
Sources
  • NCH
Profiles
  • CMS

Notes

This field is deprecated in shared systems data. Its value can be derived as Y if any CLM_BNFT_ENHNCMT_X_CD = 5, else N.

Mappings

CCLF
  • CCLFA.CLM_NGACO_CPTATN_SW

bluebutton.cms.gov

official website of theU.S. Department of Health and Human Services and theCenters for Medicare & Medicaid Services.

Looking for U.S. government information and services?
Visit USA.gov