NCH Primary Payer Claim Paid Amount

Variable Name : PRPAYAMT 

Label: NCH Primary Payer Claim Paid Amount  

The amount of a payment made on behalf of a Medicare beneficiary by a primary payer other than Medicare, that theprovider is applying to covered Medicare charges on an institutional, carrier, or DMERC claim. 9.2 DIGITS SIGNED 

DB2 ALIAS: PRMRY_PYR_PD_AMT 

SAS ALIAS: PRPAYAMT STANDARD ALIAS: NCH_PRMRY_PYR_CLM_PD_AMT

 TITLE ALIAS: PRIMARY_PAYER_AMOUNT EDIT-RULES: $$$$$$$$$CC 

COMMENT: Prior to Version H this field was named: BENE_PRMRY_PYR_CLM_PMT_AMT and the field size was S9(7)V99. 

SOURCE: NCH 

Variable Name : PRPAY_CD

Label:  NCH Primary Payer Code

The code, on an institutional claim, specifying a federal non-Medicare program or other source that has primary responsibility for the payment of the Medicare beneficiary's health insurance bills. 

DB2 ALIAS: NCH_PRMRY_PYR_CD 

SAS ALIAS: PRPAY_CD STANDARD ALIAS: NCH_PRMRY_PYR_CD 

TITLE ALIAS: PRIMARY_PAYER_CD DERIVATION: DERIVED FROM: CLM_VAL_CD CLM_VAL_AMT DERIVATION RULES SET NCH_PRMRY_PYR_CD TO 'A' WHERE THE CLM_VAL_CD = '12' SET NCH_PRMRY_PYR_CD TO 'B' WHERE THE CLM_VAL_CD = '13' SET NCH_PRMRY_PYR_CD TO 'C' WHERE THE CLM_VAL_CD = '16' and CLM_VAL_AMT is zeroes SET NCH_PRMRY_PYR_CD TO 'D' WHERE THE CLM_VAL_CD = '14' SET NCH_PRMRY_PYR_CD TO 'E' WHERE THE CLM_VAL_CD = '15' SET NCH_PRMRY_PYR_CD TO 'F' WHERE THE CLM_VAL_CD = '16' (CLM_VAL_AMT not equal to zeroes) SET NCH_PRMRY_PYR_CD TO 'G' WHERE THE CLM_VAL_CD = '43' SET NCH_PRMRY_PYR_CD TO 'H' WHERE THE CLM_VAL_CD = '41' SET NCH_PRMRY_PYR_CD TO 'I' WHERE THE CLM_VAL_CD = '42' SET NCH_PRMRY_PYR_CD TO 'L' (or prior to 4/97 set code to 'J') WHERE THE CLM_VAL_CD = '47' CODES: REFER TO: BENE_PRMRY_PYR_TB IN THE CODES APPENDIX

 COMMENT: Prior to Version H this field was named: BENE_PRMRY_PYR_CD. 

 SOURCE: NCH

Variable Name : CANCELCD

Label:  FI Requested Claim Cancel Reason Code

The reason that an intermediary requested cancelling a previously submitted institutional claim. DB2 ALIAS: RQST_CNCL_RSN_CD SAS ALIAS: CANCELCD 

STANDARD ALIAS: FI_RQST_CLM_CNCL_RSN_CD 

TITLE ALIAS: CANCEL_CD CODES: REFER TO: FI_RQST_CLM_CNCL_RSN_TB IN THE CODES APPENDIX 

COMMENT: Prior to Version H this field was named: INTRMDRY_RQST_CLM_CNCL_RSN_CD. 

SOURCE: CWF

Variable Name : ACTIONCD

Label: FI Claim Action Code

The type of action requested by the intermediary to be taken on an institutional claim. 

DB2 ALIAS: FI_CLM_ACTN_CD SAS ALIAS: ACTIONCD 

STANDARD ALIAS: FI_CLM_ACTN_CD TITLE ALIAS: ACTION_CD CODES: REFER TO: FI_CLM_ACTN_TB IN THE CODES APPENDIX

 COMMENT: Prior to Version H this field was named: INTRMDRY_CLM_ACTN_CD. 

SOURCE: CWF  

Variable Name : APRVL_DT

Label: FI Claim Process Date

The date the fiscal intermediary completes processing and releases the institutional claim to the CWF host. 8 DIGITS UNSIGNED 

DB2 ALIAS: FI_CLM_PROC_DT 

SAS ALIAS: APRVL_DT 

STANDARD ALIAS: FI_CLM_PROC_DT 

TITLE ALIAS: FI_PROCESS_DT EDIT-RULES: YYYYMMDD 

SOURCE: CWF