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Claim PPS Indicator Code

CLM_PPS_IND_CD

EFFECTIVE WITH NCH VERSION H, THE CODE INDICATING WHETHER OR NOT THE (1) CLAIM IS PPS AND/OR (2) THE BENEFICIARY IS A DEEMED INSURED MEDICARE QUALIFIED GOVERNMENT EMPLOYEE (MQGE). NOTE: BEGINNING WITH NCH WEEKLY PROCESS DATE 10/3/97 THROUGH 5/29/98, THIS FIELD WAS POPULATED WITH ONLY THE PPS INDICATOR. BEGINNING WITH NCH WEEKLY PROCESS DATE 6/5/98, THIS FIELD WAS ADDITIONALLY POPULATED WITH THE DEEMED MQGE INDICATOR. CLAIMS PROCESSED PRIOR TO 10/3/97 WILL CONTAIN SPACES. [NCH]

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_PPS_IND_CD').exists()
).code.coding.code
Coverage / Claim Type
  • HHA
  • Hospice
  • Inpatient
  • Outpatient
  • SNF
Source View
V2_MDCR_CLM_INSTNL
Source Column
CLM_PPS_IND_CD
Sources
  • NCH
Profiles
  • CMS

Example

2

Mappings

CCW
  • CLM_PPS_IND_CD
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