Variable: CLM_MDCR_NPMT_RSN_CD

Claim Nonpayment Reason Code

Description:

THE REASON THAT NO MEDICARE PAYMENT IS MADE FOR SERVICES ON AN INSTITUTIONAL CLAIM.

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 - RECOVERY AUDIT CONTRACTOR - CALIFORNIA (25 2-BYTE CODE) (EFF. 10/2005)
&	MSP COST AVOIDED - RECOVERY AUDIT CONTRACTOR - 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)
00	MEDICARE SECONDARY PAYER (MSP) COST AVOIDED - COORDINATOR OF BENEFITS (COB) CONTRACTOR 11100
12	MSP COST AVOIDED - BLUE CROSS - BLUE SHIELD VOLUNTARY AGREEMENTS COB CONTRACTOR 11112
13	MSP COST AVOIDED - OFFICE OF PERSONNEL MANAGEMENT (OPM) DATA MATCH COB CONTRACTOR 11113
14	MSP COST AVOIDED - WORKERS COMPENSATION (WC) DATA MATCH COB CONTRACTOR 11114
15	MSP COST AVOIDED - WORKERS COMPENSATION INSURER VOLUNTARY DATA SHARING AGREEMENTS (WC VDSA) COB CONTRACTOR 11115
16	MSP COST AVOIDED - LIABILITY INSURER VDSA COB CONTRACTOR 11116
17	MSP COST AVOIDED - NO-FAULT INSURER VDSA COB CONTRACTOR 11117
18	MSP COST AVOIDED - PHARMACY BENEFIT MANAGER DATA SHARING AGREEMENT COB CONTRACTOR 11118
19	MSP COST AVOIDED - WC MEDICARE SET-ASIDE ARRANGEMENT COB CONTRACTOR 11119
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 MSP FLORIDA (EFF. 10/2005) COB CONTRACTOR 11126
39	MSP COST AVOIDED - GROUP HEALTH PLAN (GHP) RECOVERY COB CONTRACTOR 11139
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
<	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	COVERED WORKERS COMPENSATION (OBSOLETE)
B	BENEFITS EXHAUSTED
C	CUSTODIAL CARE- NON-COVERED CARE (INCLUDES ALL 'BENEFICIARY AT FAULT' WAIVER CASES) (OBSOLETE)
E	MSP COST AVOIDED - INTERNAL REVENUE SERVICE (IRS)/ SOCIAL SECURITY ADMINISTRATION (SSA)/ HEALTH CARE FINANCING ADMINISTRATION (HCFA) DATA MATCH (EFF. 7/00)
F	MSP COST AVOIDED - HEALTH MAINTENANCE ORGANIZATION (HMO) RATE CELL (EFF. 7/00)
G	MSP COST AVOIDED - LITIGATION SETTLEMENT (EFF. 7/00)
H	MSP COST AVOIDED - EMPLOYER VOLUNTARY REPORTING (EFF. 7/00)
J	MSP COST AVOIDED - INSURER VOLUNTARY REPORTING (EFF. 7/00)
K	MSP COST AVOIDED - INITIAL ENROLLMENT QUESTIONNAIRE (IEQ) (EFF. 7/00)
N	ALL OTHER REASONS FOR NONPAYMENT
P	PAYMENT REQUESTED
Q	MSP COST AVOIDED - VOLUNTARY AGREEMENT (EFF. 7/00)
R	BENEFITS REFUSED, OR EVIDENCE NOT SUBMITTED
T	MSP COST AVOIDED - IEQ CONTRACTOR (EFF. 9/76) (OBSOLETE 6/30/00)
U	MSP COST AVOIDED - HMO RATE CELL ADJUSTMENT (EFF. 9/76) (OBSOLETE 6/30/00)
V	MSP COST AVOIDED - LITIGATION SETTLEMENT (EFF. 9/76) (OBSOLETE 6/30/00)
W	WORKER'S COMPENSATION (OBSOLETE)
X	MSP COST AVOIDED - GENERIC
Y	MSP COST AVOIDED - IRS/SSA DATA MATCH PROJECT (OBSOLETE 6/30/00)
Z	ZERO REIMBURSEMENT REQUEST FOR ANTICIPATED PAYMENTS (RAPS) - ZERO REIMBURSEMENT MADE DUE TO MEDICAL REVIEW INTERVENTION OR WHERE PROVIDER SPECIFIC ZERO PAYMENT HAS BEEN DETERMINED. (EFFECTIVE WITH HHPPS - 10/00)
~	NO DESCRIPTION AVAILABLE