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Claim NGACO Telehealth Switch

CLM_NGACO_TLHLTH_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 THE BENEFIT ENHANCEMENT INDICATOR THAT IDENTIFIES CLAIMS THAT QUALIFY FOR SPECIFIC CLAIM PROCESSING EDITS. VALID VALUES: Y = IF ANY OF THE FIVE CLAIM NG ACO INDICATOR CODES CONTAINS Ñ²Ò (TELEHEALTH). N = IF Ѷ4Ò OR Ѹ9Ò IS FOUND IN ANY OF THE CLM_DCMTN.CLM_DEMO_1ST_NUM THROUGH CLM_DCMTN.CLM_DEMO_5TH_NUM COLUMNS AND NONE OF THE FIVE NG ACO INDICATOR CODES CONTAINS ѲҮ 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_TLHLTH_SW').exists()
).value
Coverage / Claim Type
  • HHA
  • Hospice
  • Inpatient
  • Outpatient
  • SNF
Source View
V2_MDCR_CLM_DCMTN
Source Column
CLM_NGACO_TLHLTH_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 = 2, else N.

Mappings

CCLF
  • CCLFA.CLM_NGACO_TLHLTH_SW

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