Variable: CARR_CLM_PMT_DNL_CD
Carrier Claim Payment Denial Code
Description
The code on a non-institutional claim indicating to whom payment was made or if the claim was denied.
Comment
Effective with Version 'J', the field was expanded on the NCH record to 2 bytes, With his expansion, the NCH will no longer use the character values to represent the official two byte values sent in by NCH since 4/2002. During the Version J conversion, all character values were converted to the two byte values. On 4/1/02, this field was expanded to two bytes to accommodate new values. The NCH Nearline file did not expand the current 1-byte field but instituted a crosswalk of the 2-byte field to the 1-byte character value.
Values
This variable is coded, and will contain one of the following values.
| Value | Description |
|---|---|
| 0 | Denied |
| 1 | Physician/supplier |
| 2 | Beneficiary |
| 3 | Both physician/supplier and beneficiary |
| 4 | Hospital (hospital based physicians) |
| 5 | Both hospital and beneficiary |
| 6 | Group practice prepayment plan |
| 7 | Other entries (e.g. Employer, union) |
| 8 | Federally funded |
| 9 | PA service |
| A | Beneficiary under limitation of liability |
| B | Physician/supplier under limitation of liability |
| D | Denied due to demonstration involvement |
| E | MSP cost avoided IRS/SSA/HCFA Data Match (after 01/2001 is First Claim Development) |
| F | MSP cost avoided HMO Rate Cell (after 1/2001 is Trauma Code Development) |
| G | MSP cost avoided Litigation Settlement (after 1/2001 is Secondary Claims Investigation) |
| H | MSP cost avoided Employer Voluntary Reporting (after 1/2001 is Self-Reports) |
| J | MSP cost avoided Insurer Voluntary Reporting (eff. 7/3/00) |
| K | MSP cost avoided Initial Enrollment Questionnaire (eff. 7/3/00) |
| P | Physician ownership denial |
| Q | MSP cost avoided - voluntary agreements including with employer |
| T | MSP cost avoided - Initial Enrollment Questionnaire |
| 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 |
| 00 | MSP cost avoided - COB Contractor |
| 12 | MSP cost avoided - BC/BS Voluntary Data Sharing Agreements (VDSA) |
| 13 | MSP cost avoided - Office of Personnel Management (OPM) Data Match |
| 14 | MSP cost avoided - Workman's Compensation (WC) Data Match |
| 15 | MSP cost avoided - Workman's Compensation Insurer Voluntary Data Sharing Agreements (WC VDSA) |
| 16 | MSP cost avoided - Liability Insurer VDSA |
| 17 | MSP cost avoided - No-Fault Insurer VDSA |
| 18 | MSP cost avoided - Pharmacy Benefit Manager Data Sharing Agreement |
| 21 | MSP cost avoided - MIR Group Health Plan |
| 22 | MSP cost avoided - MIR non-Group Health Plan |
| 25 | MSP cost avoided - Recovery Audit Contractor – California |
| 26 | MSP cost avoided - Recovery Audit Contractor – Florida |
| 41 | MSP cost avoided - non-Group Health Plan non-Ongoing responsibility for medical (ORM) |
| 43 | MSP cost avoided - Medicare Part C/Medicare Advantage |
| ! | MSP cost avoided - COB Contractor (converted to '00' 2-byte code) |
| @ | MSP cost avoided - BC/BS Voluntary Agreements (converted to '12' 2-byte code) |
| # | MSP cost avoided - Office of Personnel Management (converted to '13' 2-byte code) |
| $ | MSP cost avoided - Workman's Compensation (WC) Datamatch (converted to '14' 2-byte code) |
| * | MSP cost avoided - Workman's Compensation Insurer Voluntary Data Sharing Agreements (WC VDSA) (eff. 4/2006) (converted to '15' 2-byte code) |
| ( | MSP cost avoided - Liability Insurer VDSA (eff. 4/2006) (converted to '16' 2-byte code) |
| ) | MSP cost avoided - No-Fault Insurer VDSA (eff. 4/2006) (converted to '17' 2-byte code) |
| + | MSP cost avoided - Pharmacy Benefit Manager Data Sharing Agreement (eff. 4/2006) (converted to '18' 2 -byte code) |
| < | MSP cost avoided - MIR Group Health Plan (eff. 1/2009) (converted to '21' 2-byte code) |
| > | MSP cost avoided - MIR non-Group Health Plan (eff. 1/2009) (converted to '22' 2-byte code) |
| % | MSP cost avoided - Recovery Audit Contractor - California (eff. 10/2005) (converted to '25' 2-byte code) |
| & | MSP cost avoided - Recovery Audit Contractor - Florida (eff. 10/2005) (converted to '26' 2-byte code) |
Other Info
Some additional information on this variable:
- Short Name: PMTDNLCD
- Long Name: CARR_CLM_PMT_DNL_CD
- Type: CHAR
- Length: 2
- Source: NCH
- Value Format: