Variable: CLM_PRCSG_IND_CD

Processing Indicator Code

Description:

The code on a non-institutional claim indicating to whom payment was made or if the claim was denied.

Values

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

Value	Description
A	Allowed
B	Benefits exhausted
C	Non-covered care
D	Denied (from BMAD)
G	MSP cost avoided — Secondary Claims Investigation
H	MSP cost avoided — Self Reports
I	Invalid data
J	MSP cost avoided — 411.25
K	MSP cost avoided — Insurer Voluntary Reporting
L	CLIA
M	Multiple submittal-duplicate line item
N	Medically unnecessary
O	Other
P	Physician ownership denial
Q	MSP cost avoided (contractor #88888) — voluntary agreement
R	Reprocessed adjustments based on subsequent reprocessing of claim
S	Secondary payer
T	MSP cost avoided — IEQ contractor
U	MSP cost avoided — HMO rate cell adjustment
V	MSP cost avoided — litigation settlement
X	MSP cost avoided — generic
Y	MSP cost avoided — IRS/SSA data match project
Z	Bundled test, no payment
00	MSP cost avoided — COB Contractor
12	MSP cost avoided — BC/BS Voluntary Agreements
13	MSP cost avoided — Office of Personnel Management
14	MSP cost avoided — Workman's Compensation (WC) Datamatch
15	MSP cost avoided — Workman's Compensation Insurer Voluntary Data Sharing Agreements (WC VDSA) (eff. 4/2006)
16	MSP cost avoided — Liability Insurer VDSA (eff.4/2006)
17	MSP cost avoided — No-Fault Insurer VDSA (eff.4/2006)
18	MSP cost avoided — Pharmacy Benefit Manager Data Sharing Agreement (eff.4/2006)
21	MSP cost avoided — MIR Group Health Plan (eff.1/2009)
22	MSP cost avoided — MIR non-Group Health Plan (eff.1/2009)
25	MSP cost avoided — Recovery Audit Contractor — California (eff.10/2005)
26	MSP cost avoided — Recovery Audit Contractor — Florida (eff.10/2005)