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Variable: LINE_PRCSG_IND_CD

Line Processing Indicator Code

Description

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

Comment

Values

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

Values for Codeset
Value Description
A Allowed
B Benefits exhausted
C Non-covered care
D Denied (from BMAD)
I Invalid data
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) Effective 4/1/02, the Line Processing Indicator code was expanded to a 2-byte field. The NCH instituted a crosswalk from the 2-byte code to a 1-byte character code. Below are the character codes (found in NCH & NMUD). At some point, NMUD will carry the 2-byte code but NCH will continue to have the 1-byte character code. ! MSP cost avoided - COB Contractor ('00' 2-byte code) @ MSP cost avoided - BC/BS Voluntary Agreements ('12' 2-byte code) # MSP cost avoided - Office of Personnel Management ('13' 2-byte code) $ MSP cost avoided - Workman's Compensation (WC) Datamatch ('14' 2-byte code) * MSP cost avoided - Workman's Compensation Insurer Voluntary Data Sharing Agreements (WC VDSA) ('15' 2-byte code) (eff. 4/2006) ( 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 - Pharmacy Benefit Manager Data Sharing Agreement ('18' 2-byte code) (eff. 4/2006) < 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 - 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)

Other Info

Some additional information on this variable: