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 |