Variable: CLM_BNFT_ENHNCMT_CD
Claim Benefit Enhancement Code
Description:
Claim Benefit Enhancement Codes
Values
This variable is coded, and will contain one of the following values.
| Value | Description |
| 0 | THE PROVIDER IS ALIGNED TO THE BENEFICIARY'S ACO FOR THIS CLAIM LINE. APPLICABLE ONLY TO PROFESSIONAL LINES. |
| 1 | POPULATION BASED PAYMENTS (PBP) |
| 2 | TELEHEALTH |
| 3 | POST DISCHARGE HOME VISITS |
| 4 | THREE DAY SNF - WAIVER |
| 5 | CAPITATION (AIPBP/TCC) |
| 6 | COMPREHENSIVE ESRD CARE (CEC) TELEHEALTH |
| 7 | CARE MANAGEMENT HOME VISITS |
| 8 | PROSPECTIVE PRIMARY CARE PAYMENT (PPCP) |
| 9 | HOME HEALTH HOMEBOUND WAIVER |
| A | DIABETIC SHOES |
| B | CONCURRENT CARE FOR BENEFICIARIES THAT ELECT THE MEDICARE HOSPICE BENEFITS |
| C | KIDNEY DISEASE EDUCATION (KDE) |
| D | SERIOUSLY ILL POPULATION (SIP) |
| E | PRIMARY CARE FIRST FLAT VISIT FEE (PCF - FVF) |
| F | QUARTERLY CAPITATION PAYMENT (QCP) |
| G | PERFORMANCE BASED ADJUSTMENT (PBA) |
| H | HOME INFUSION THERAPY |
| I | MEDICAL NUTRITION THERAPY |
| J | HOSPICE CARE CERTIFICATION |
| K | CARDIAC AND PULMONARY REHABILITATION |
| L | MCP MODEL TRACK 1 BENEFICIARY OR PROVIDER |
| M | MCP MODEL TRACK 2 BENEFICIARY OR PROVIDER |
| N | MCP MODEL TRACK 3 BENEFICIARY OR PROVIDER |
| O | GUIDE MODEL BENEFICIARY COVERING ALL SERVICES |
| Q | AHEAD MODEL -100% REDUCTION (ZERO-PAY) |
| R | MDPCP AHEAD MODEL- PERCENTAGE REDUCTION (CAPITATION) |
| Z0 | PACE STRADDLE CLAIM |
| ~ | NO DESCRIPTION AVAILABLE |