Variable: Claim Payment Denial Code

Variable: CLM_CARR_PMT_DNL_CD

Claim Payment Denial Code

Description:

The code on a non-institutional claim indicating who receives payment or if the claim was denied.

Values

This variable is coded, and will contain one of the following values.

Value	Description
!	MSP COST AVOIDED - COB CONTRACTOR ('00' 2-BYTE CODE)
#	MSP COST AVOIDED - OFFICE OF PERSONNEL MANAGEMENT ('13' 2-BYTE CODE)
$	MSP COST AVOIDED - WORKMAN'S COMPENSATION (WC) DATA MATCH ('14' 2-BYTE CODE)
%	MSP COST AVOIDED - RAC - CALIFORNIA ('25' 2-BYTE CODE) (EFF. 10/2005)
&	MSP COST AVOIDED - RAC - FLORIDA ('26' 2-BYTE CODE) (EFF. 10/2005)
(	MSP COST AVOIDED - LIABILITY INSURER VDSA ('16' 2-BYTE CODE) (EFF. 4/2006)
)	MSP COST AVOIDED - NO-FAULT INSURER VDSA ('17' 2-BYTE CODE) (EFF. 4/2006)
*	MSP COST AVOIDED - WORKMAN'S COMPENSATION INSURER VOLUNTARY DATA SHARING AGREEMENTS (WC VDSA) ('15' 2-BYTE CODE) (EFF. 4/2006)
+	MSP COST AVOIDED - PHARMACY BENEFIT MANAGER DATA SHARING AGREEMENT ('18' 2 -BYTE CODE) (EFF. 4/2006)
0	DENIED
00	MEDICARE SECONDARY PAYER (MSP) COST AVOIDED - COORDINATOR OF BENEFITS (COB) CONTRACTOR 11100
1	PHYSICIAN/SUPPLIER
12	MSP COST AVOIDED - BLUE CROSS (BC)/ BLUE SHIELD (BS) VOLUNTARY AGREEMENTS COB CONTRACTOR 11112
13	MSP COST AVOIDED - OFFICE OF PERSONNEL MANAGEMENT COB CONTRACTOR 11113
14	MSP COST AVOIDED - WORKMAN'S COMPENSATION (WC) DATA MATCH COB CONTRACTOR 11114
15	MSP COST AVOIDED - WORKMAN'S COMPENSATION INSURER VOLUNTARY DATA SHARING AGREEMENTS (WC VDSA) (EFF. 4/2006) COB CONTRACTOR 11115
16	MSP COST AVOIDED - LIABILITY INSURER VDSA (EFF.4/2006) COB CONTRACTOR 11116
17	MSP COST AVOIDED - NO-FAULT INSURER VDSA (EFF.4/2006) COB CONTRACTOR 11117
18	MSP COST AVOIDED - PHARMACY BENEFIT MANAGER DATA SHARING AGREEMENT (EFF.4/2006) COB CONTRACTOR 11118
19	MSP COST AVOIDED - WC MEDICARE SET-ASIDE ARRANGEMENT COB CONTRACTOR 11119
2	BENEFICIARY
21	MSP COST AVOIDED - MANDATORY INSURER REPORTING (MIR) GROUP HEALTH PLAN (EFF.1/2009) COB CONTRACTOR 11121
22	MSP COST AVOIDED - MIR NON-GROUP HEALTH PLAN (EFF.1/2009) COB CONTRACTOR 11122
25	MSP COST AVOIDED - RECOVERY AUDIT CONTRACTOR (RAC)- CALIFORNIA (EFF.10/2005) COB CONTRACTOR 11125
26	MSP COST AVOIDED - RAC- FLORIDA (EFF.10/2005) COB CONTRACTOR 11126
3	BOTH PHYSICIAN/SUPPLIER AND BENEFICIARY
39	MSP COST AVOIDED - GROUP HEALTH PLAN (GHP) RECOVERY COB CONTRACTOR 11139
4	HOSPITAL (HOSPITAL BASED PHYSICIANS)
41	MSP COST AVOIDED - NON-GROUP HEALTH PLAN (NGHP) NON-ONGOING RESPONSIBILITY FOR MEDICALS (ORM) COB CONTRACTOR 11141
42	MSP COST AVOIDED - NGHP ORM RECOVERY COB CONTRACTOR 11142
43	MEDICARE PART C/ MEDICARE ADVANTAGE/ COB CONTRACTOR 11143
5	BOTH HOSPITAL AND BENEFICIARY
6	GROUP PRACTICE PREPAYMENT PLAN
7	OTHER ENTRIES (E.G. EMPLOYER , UNION)
8	FEDERALLY FUNDED
9	PA SERVICE
<	MSP COST AVOIDED - MIR GROUP HEALTH PLAN ('21' 2-BYTE CODE) (EFF. 1/2009)
>	MSP COST AVOIDED - MIR NON-GROUP HEALTH PLAN ('22' 2-BYTE CODE) (EFF. 1/2009)
@	MSP COST AVOIDED - BC/BS VOLUNTARY AGREEMENTS ('12' 2-BYTE CODE)
A	ALLOWED
B	BENEFITS EXHAUSTED
C	NON-COVERED CARE
D	DENIED DUE TO DEMONSTRATION INVOLVEMENT (EFF. 5/97)
E	FIRST CLAIM DEVELOPMENT
F	TRAUMA CODE DEVELOPMENT
G	SECONDARY CLAIMS INVESTIGATION
H	SELF REPORTS
J	411.25
K	INSURER VOLUNTARY REPORTING
L	CLINICAL LAB IMPROVEMENT AMENDMENT (CLIA)
M	MULTIPLE SUBMITTAL (I.E. DUPLICATE LINE ITEM)
N	MEDICAL NECESSITY
O	OTHER
P	PHYSICIAN OWNERSHIP DENIAL (EFF 3/92)
Q	EMPLOYER VOLUNTARY REPORTING
R	REPROCESSED ADJUSTMENT BASED ON SUBSEQUENT REPROCESSING OF CLAIM
S	SECONDARY PAYER
T	MSP COST AVOIDED - INITIAL ENROLLMENT QUESTIONNAIRE (IEQ) CONTRACTOR (EFF. 7/96)
U	MSP COST AVOIDED - HEALTH MAINTENANCE ORGANIZATION (HMO) RATE CELL ADJUSTMENT (EFF. 7/96)
V	MSP COST AVOIDED - LITIGATION SETTLEMENT (EFF. 7/96)
X	MSP COST AVOIDED - GENERIC
Y	MSP COST AVOIDED - IRS/SSA DATA MATCH PROJECT
Z	ZERO PAYMENT , ALLOWED TEST
~	NO DESCRIPTION AVAILABLE