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) |