Home Health Agency

Variable Name : MQA_RIC

Label :  NCH MQA RIC Code

Effective with Version H, the code used (for internal editing purposes) to identify the record being processed through HCFA's CWFMQA system. 

NOTE: Beginning with NCH weekly process date 10/3/97 field was populated with data. Claims processed prior to 10/3/97 will contain spaces in this field. 

DB2 ALIAS: NCH_MQA_RIC_CD 

SAS ALIAS: MQA_RIC STANDARD ALIAS: NCH_MQA_RIC_CD 

TITLE ALIAS: MQA_RIC 

CODES: 

1 = Inpatient 

2 = SNF 

3 = Hospice 

4 = Outpatient 

5 = Home Health Agency

6 = Physician/Supplier 

7 = Durable Medical Equipment 

SOURCE: NCH QA PROCESS 

Variable Name : CLM_TYPE

Label :  NCH Claim Type Code 

The code used to identify the type of claim record being processed in NCH. 

NOTE1: During the Version H conversion this field was populated with data through- out history (back to service year 1991). NOTE2: During the Version I conversion this field was expanded to include inpatient 'full' encounter claims (for service dates after 6/30/97). Placeholders for Physician and Outpatient encounters (available in NMUD) have also been added. 

DB2 ALIAS: NCH_CLM_TYPE_CD 

SAS ALIAS: CLM_TYPE 

STANDARD ALIAS: NCH_CLM_TYPE_CD 

SYSTEM ALIAS: LTTYPE 

TITLE ALIAS: CLAIM_TYPE 

DERIVATION: FFS CLAIM TYPE CODES 

DERIVED FROM: 

NCH CLM_NEAR_LINE_RIC_CD 

NCH PMT_EDIT_RIC_CD 

NCH CLM_TRANS_CD 

NCH PRVDR_NUM

INPATIENT 'FULL' ENCOUNTER TYPE CODE DERIVED FROM: 

(Pre-HDC processing -- AVAILABLE IN NCH) CLM_MCO_PD_SW CLM_RLT_COND_CD MCO_CNTRCT_NUM MCO_OPTN_CD 

MCO_PRD_EFCTV_DT 

MCO_PRD_TRMNTN_DT 

INPATIENT 'FULL' ENCOUNTER TYPE CODE DERIVED FROM: (HDC processing -- AVAILABLE IN NMUD) FI_NUM 

INPATIENT 'ABBREVIATED' ENCOUNTER TYPE CODE DERIVED FROM: (HDC processing -- AVAILABLE IN NMUD) FI_NUM CLM_FAC_TYPE_CD CLM_SRVC_CLSFCTN_TYPE_CD CLM_FREQ_CD 

NOTE: From 7/1/97 to the start of HDC processing(?), abbreviated inpatient encounter claims are not available in NCH or NMUD.

 PHYSICIAN 'FULL' ENCOUNTER TYPE CODE DERIVED FROM: (AVAILABLE IN NMUD) CARR_NUM CLM_DEMO_ID_NUM OUTPATIENT 'FULL' ENCOUNTER TYPE CODE DERIVED 

 FROM: (AVAILABLE IN NMUD) FI_NUM OUTPATIENT 'ABBREVIATED' ENCOUNTER TYPE 

CODE DERIVED FROM: (AVAILABLE IN NMUD) FI_NUM CLM_FAC_TYPE_CD CLM_SRVC_CLSFCTN_TYPE_CD CLM_FREQ_CD 

DERIVATION RULES: 

SET CLM_TYPE_CD TO 10 (HHA CLAIM) WHERE THE FOLLOWING CONDITIONS ARE MET: 

1. CLM_NEAR_LINE_RIC_CD EQUAL 'V','W' OR 'U'

2. PMT_EDIT_RIC_CD EQUAL 'F' 

3. CLM_TRANS_CD EQUAL '5' SET CLM_TYPE_CD TO 20 (SNF NON-SWING BED CLAIM) WHERE THE FOLLOWING CONDITIONS ARE MET: 

 1. CLM_NEAR_LINE_RIC_CD EQUAL 'V' 

 2. PMT_EDIT_RIC_CD EQUAL 'C' OR 'E' 

 3. CLM_TRANS_CD EQUAL '0' OR '4' 

 4. POSITION 3 OF PRVDR_NUM IS NOT 'U', 'W', 'Y' OR 'Z' SET CLM_TYPE_CD TO 30 (SNF SWING BED CLAIM) WHERE THE FOLLOWING CONDITIONS ARE MET:

 1. CLM_NEAR_LINE_RIC_CD EQUAL 'V' 

 2. PMT_EDIT_RIC_CD EQUAL 'C' OR 'E' 3. CLM_TRANS_CD EQUAL '0' OR '4' 4. POSITION 3 OF PRVDR_NUM EQUAL 'U', 'W', 'Y' OR 'Z' SET CLM_TYPE_CD TO 40 (OUTPATIENT CLAIM) WHERE THE FOLLOWING CONDITIONS ARE MET: 

 1. CLM_NEAR_LINE_RIC_CD EQUAL 'W' 

 2. PMT_EDIT_RIC_CD EQUAL 'D' 

 3. CLM_TRANS_CD EQUAL '6' SET CLM_TYPE_CD TO 41 (OUTPATIENT 'FULL'  

ENCOUNTER CLAIM -- AVAILABLE IN NMUD) WHERE THE FOLLOWING CONDITIONS ARE MET: 1. CLM_NEAR_LINE_RIC_CD EQUAL 'W' 2. PMT_EDIT_RIC_CD EQUAL 'D' 3. CLM_TRANS_CD EQUAL '6' 4. FI_NUM = 80881 SET CLM_TYPE_CD TO 42 (OUTPATIENT ENCOUNTER CLAIMS -- AVAILABLE IN NMUD) 

 1. FI_NUM = 80881 

 2. CLM_FAC_TYPE_CD = '1' OR '8'; CLM_SRVC_ CLSFCTN_TYPE_CD = '2', '3' OR '4' & CLM_FREQ_CD = 'Z', 'Y' OR 'X' SET CLM_TYPE_CD TO 50 (HOSPICE CLAIM) WHERE THE FOLLOWING CONDITIONS ARE MET: 

 1. CLM_NEAR_LINE_RIC_CD EQUAL 'V' 

 2. PMT_EDIT_RIC_CD EQUAL 'I' 

 3. CLM_TRANS_CD EQUAL 'H' SET CLM_TYPE_CD TO 60 (INPATIENT CLAIM) WHERE THE FOLLOWING CONDITIONS ARE MET: 

 1. CLM_NEAR_LINE_RIC_CD EQUAL 'V' 

 2. PMT_EDIT_RIC_CD EQUAL 'C' OR 'E' 

 3. CLM_TRANS_CD EQUAL '1' '2' OR '3' SET CLM_TYPE_CD TO 61 (INPATIENT 'FULL' ENCOUNTER CLAIM - PRIOR TO HDC PROCESSING - AFTER 6/30/97 - 12/4/00) WHERE THE FOLLOWING CONDITIONS ARE MET: 

 1. CLM_MCO_PD_SW = '1' 

 2. CLM_RLT_COND_CD = '04' 

3. MCO_CNTRCT_NUM MCO_OPTN_CD = 'C' CLM_FROM_DT & CLM_THRU_DT ARE WITHIN THE MCO_PRD_EFCTV_DT & MCO_PRD_TRMNTN_DT ENROLLMENT PERIODS SET_CLM_TYPE_CD TO 61 (INPATIENT 'FULL' ENCOUNTER CLAIM -- EFFECTIVE WITH HDC PROCESSING) WHERE THE FOLLOWING CONDITIONS ARE MET: 

 1. CLM_NEAR_LINE_RIC_CD EQUAL 'V' 

 2. PMT_EDIT_RIC_CD EQUAL 'C' OR 'E' 

 3. CLM_TRANS_CD EQUAL '1' '2' OR '3' 

 4. FI_NUM = 80881 SET CLM_TYPE_CD TO 62 (INPATIENT 'ABBREVIATED' ENCOUNTER CLAIM -- AVAILABLE IN NMUD) WHERE THE FOLLOWING CONDITIONS ARE MET: 

 1. FI_NUM = 80881 AND 2. CLM_FAC_TYPE_CD = '1'; CLM_SRVC_CLSFCTN_ TYPE_CD = '1'; CLM_FREQ_CD = 'Z' SET CLM_TYPE_CD TO 71 (RIC O non-DMEPOS CLAIM) WHERE THE FOLLOWING CONDITIONS ARE MET: 

 1. CLM_NEAR_LINE_RIC_CD EQUAL 'O' 

 2. HCPCS_CD not on DMEPOS table SET CLM_TYPE_CD TO 72 (RIC O DMEPOS CLAIM) WHERE THE FOLLOWING CONDITIONS ARE MET:

 1. CLM_NEAR_LINE_RIC_CD EQUAL 'O' 

2. HCPCS_CD on DMEPOS table (NOTE: if one or more line item(s) match the HCPCS on the  DMEPOS table). SET CLM_TYPE_CD TO 73 (PHYSICIAN ENCOUNTER CLAIM-- EFFECTIVE WITH HDC PROCESSING) WHERE THE FOLLOWING CONDITIONS ARE MET: 1. CARR_NUM = 80882 AND 

 2. CLM_DEMO_ID_NUM = 38 SET CLM_TYPE_CD TO 81 (RIC M non-DMEPOS DMERC CLAIM) WHERE THE FOLLOWING CONDITIONS ARE MET: 1. CLM_NEAR_LINE_RIC_CD EQUAL 'M' 2. HCPCS_CD not on 

DMEPOS table SET CLM_TYPE_CD TO 82 (RIC M DMEPOS DMERC CLAIM) WHERE THE FOLLOWING CONDITIONS ARE MET: 

 1. CLM_NEAR_LINE_RIC_CD EQUAL 'M'  

2. HCPCS_CD on DMEPOS table 

(NOTE: if one or more line item(s) match the HCPCS on the DMEPOS table). CODES: REFER TO: NCH_CLM_TYPE_TB IN THE CODES APPENDIX SOURCE: NCH