Variable Name: DEMOIND{x}
where { x } ranges from 1 to 5
Label: NCH Demonstration Trailer Indicator Code
Effective with Version H, the code indicating the presence
of a demo trailer.
NOTE: During the Version H conversion this field
was populated throughout history (back to service
year 1991).
COBOL ALIAS: DEMO_IND
DB2 ALIAS: DEMO_TRLR_IND_CD
SAS ALIAS: DEMOIND
STANDARD ALIAS: NCH_DEMO_TRLR_IND_CD
TITLE ALIAS: DEMO_INDICATOR
CODES:
D = Demo trailer present
SOURCE:
NCH
Variable Name: DEMONUM{x}
where { x } ranges from 1 to 5
Label: Claim Demonstration Identification Number
Effective with Version H, the number assigned to identify a
demo. This field is also used to denote special processing
(a.k.a. Special Processing
Number, SPN).
NOTE: Prior to Version H, Demo ID was stored in the
redefined Claim Edit Group, 4th occurrence, positions
3 and 4. During the H conversion, this field was
populated with data throughout history (as appropriate
either by moving ID on Version G or by
deriving from specific demo criteria).
01 = Nursing Home Case-Mix and Quality: NHCMQ
(RUGS) Demo -- testing PPS for SNFs in 6
states, using a case-mix classification
system based on resident characteristics and
actual resources used. The claims carry a
RUGS indicator and one or more revenue center
codes in the 9,000 series.
NOTE1: Effective for SNF claims with NCH weekly
process date after 2/8/96 (and service date after
12/31/95) -- beginning 4/97, Demo ID '01' was
derived in NCH based on presence of RUGS phase #
'2','3' or '4' on incoming claim; since 7/97, CWF
has been adding ID to claim.
NOTE2: During the Version H conversion, Demo ID
'01' was populated back to NCH weekly process date
2/9/96 based on the RUGS phase indicator (stored
in Claim Edit Group, 3rd occurrence, 4th position,
in Version G).
02 = National HHA Prospective Payment Demo --
testing PPS for HHAs in 5 states, using two alternate methods of paying HHAs: per visit
by type of HHA visit and per episode of HH
care.
NOTE1: Effective for HHA claims with NCH weekly
process date after 5/31/95 -- beginning 4/97,
Demo ID '02' was derived in NCH based on HCFA/
CHPP-supplied listing of provider # and start/
stop dates of participants.
NOTE2: During the Version H conversion, Demo ID
'02' was populated back to NCH weekly process
date 6/95 based on the CHPP criteria.
03 = Telemedicine Demo -- testing covering traditionally
noncovered physician services for
medical consultation furnished via two-way, interactive
video systems (i.e. teleconsultation)
in 4 states. The claims contain line items
with 'QQ' HCPCS code.
NOTE1: Effective for physician/supplier (nonDMERC)
claims with NCH weekly process date after 12/31/96
(and service date after 9/30/96) -- since 7/97,
CWF has been adding Demo ID '03' to claim.
NOTE2: During Version H conversion, Demo ID '03'
was populated back to NCH weekly process date 1/97
based on the presence of 'QQ' HCPCS on one or more
line items.
04 = United Mine Workers of America (UMWA) Managed
Care Demo -- testing risk sharing for Part A
services, paying special capitation rates for
all UMWA beneficiaries residing in 13 designated
counties in 3 states. Under the demo,
UMWA will waive the 3-day qualifying hospital
stay for a SNF admission. The claims contain
TOB '18X','21X','28X' and '51X'; condition
code = W0; claim MCO paid switch = not '0';
and MCO contract # = '90091'.
NOTE: Initially scheduled to be implemented for
all SNF claims for admission or services on
1/1/97 or later, CWF did not transmit any Demo
ID '04' annotated claims until on or about 2/98.
05 = Medicare Choices (MCO encounter data) demo --
testing expanding the type of Managed Care
plans available and different payment methods
at 16 MCOs in 9 states. The claims contain
one of the specific MCO Plan Contract #
assigned to the Choices Demo site.
NOTE1: Effective for all claim types with NCH
weekly process date after 7/31/97 -- CWF adds
Demo ID '05' to claim based on the presences of
the MCO Plan Contract #.
NOTE2: During the Version H conversion, Demo ID
'05' was populated back to NCH weekly process
date 8/97 based on the presence of the Choices
indicator (stored as an alpha character crosswalked
from MCO plan contract # in the Claim
Edit Group, 4th occurrence, 2nd position, in
Version 'G').
06 = Coronary Artery Bypass Graft (CABG) Demo --
testing bundled payment (all-inclusive global pricing) for hospital + physician services
related to CABG surgery in 7 hospitals in 7
states. The inpatient claims contain a DRG
'106' or '107'.
NOTE1: Effective for Inpatient claims and
physician/supplier claims with Claim Edit Date
no earlier than 6/1/91 (not all CABG sites
started at the same time) -- on 5/1/97, CWF
started transmitting Demo ID '06' on the claim.
The FI adds the ID to the claim based on the
presence of DRG '106' or '107' from specific
providers for specified time periods; the
carrier adds the ID to the claim based on
receiving 'Daily Census List' from parti
-
cipating hospitals. Demo ID '06' will end
once Demo ID '07' is implemented.
NOTE2: During the Version H conversion, any
claims where Medicare is the primary payer
that were not already identified as Demo ID
'06' (stored in the redefined Claim Edit
Group, 4th occurrence, positions 3 and 4,
Version G) were annotated based on the follow
-
ing criteria: Inpatient - presence of DRG '106'
or '107' and a provider number=220897, 150897,
380897,450897,110082,230156 or 360085 for
specified service dates; noninstitutional
-
presence of HCPCS modifier (initial and/or
second) = 'Q2' and a carrier number =00700/31143
00630,01380,00900,01040/00511,00710,00623, or
13630 for specified service dates.
07 = Participating Centers of Excellence (PCOE)
Demo -- testing a negotiated all-inclusive
pricing arrangement (bundled rates) for highcost
acute care cardiovascular and orthopedic
procedures performed in 60-100 premier facili
-
ties in the Chicago and San Francisco Regions
or by current CABG providers. The inpatient
claims will contain a DRG '104','105','106',
'107','112','124','125','209',or '471'; the
related physician/supplier claims will contain
the claim payment denial reason code = 'D'.
NOTE: The demo is on HOLD. The FI and carrier will
add Demo ID '07' to claim.
08 = Provider Partnership Demo -- testing per-case
payment approaches for acute inpatient
hospitalizations, making a lump-sum payment
(combining the normal Part A PPS payment with
the Part B allowed charges into a single fee
schedule) to a Physician/Hospital Organization
for all Part A and Part B services associated
with a hospital admission. From 3 to 6 hospitals
in the Northeast and Mid-Atlantic regions may
participate in the demo.
NOTE: The demo is on HOLD. The FI and carrier will
add Demo ID '08' to claim.
15 = ESRD Managed Care (MCO encounter data) -
-
testing open enrollment of ESRD beneficiaries
and capitation rates adjusted for patient treatment needs at 3 MCOs in 3 States. The
claims contain one of the specific MCO Plan
Contract # assigned to the ESRD demo site.
NOTE: Effective 10/1/97 (but not actually implemented
at a site until 1/1/98) for all claim
types -- the FI and carrier add Demo ID '15' to
claim based on the presence of the MCO plan
contract #.
30 = Lung Volume Reduction Surgery (LVRS) or
National Emphysema Treatment Trial (NETT)
Clinical Study -- evaluating the effectiveness
of LVRS and maximum medical therapy (including
pulmonary rehab) for Medicare beneficiaries
in last stages of emphysema at 18
hospitals nationally, in collaboration with
NIH.
NOTE: Effective for all claim types (except DMERC)
with NCH weekly process date after 2/27/98 (and
service date after 10/31/97) -- the FI adds Demo ID
'30' based on the presence of a condition code = EY;
the participating physician (not the carrier) adds
ID to the noninstitutional claim. DUE TO THE SENSITIVE
NATURE OF THIS CLINICAL TRIAL AND UNDER
THE
TERMS OF THE INTERAGENCY AGREEMENT WITH NIH,
THESE
CLAIMS ARE PROCESSED BY CWF AND TRANSMITTED
TO
HCFA BUT NOT STORED IN THE NEARLINE FILE (access
is restricted to study evaluators only).
31 = VA Pricing Special Processing (SPN) -- not really
a demo but special request from VA due to
court settlement; not Medicare services but
VA inpatient and physician services submitted
to FI 00400 and Carrier 00900 to obtain
Medicare pricing -- CWF WILL PROCESS VA
CLAIMS ANNOTATED WITH DEMO ID '31', BUT WILL
NOT TRANSMIT TO HCFA (not in Nearline File).
37 = Medicare Coordinated Care Demonstration -- to test
whether coordinated care services furnished to
certain beneficiaries improve outcomes of care
and reduce Medicare expenditures under Part A and
Part B. There will be at least 9 Coordinated
Care Entities (CCEs). The selected entities will
be assigned a provider number specifically for the
demonstration services.
NOTE: The demo is on HOLD. The FI and carrier will
add Demo ID '37' to claim.
38 = Physician Encounter Claims - the purpose of this
demo id is to identify the physician encounter
claims being processed at the HCFA Data Center (HDC).
This number will help EDS in making the claim go
through the appropriate processing logic, which
differs from that for fee-for-service. **NOT
IN NCH -- AVAILABLE IN NMUD.**
NOTE: Effective October, 2000. Demo ids will not be
assigned to Inpatient and Outpatient encounter claims.
39 = Centralized Billing of Flu and PPV Claims -- The purpose of this demo is to facilitate the processing
carrier, Trailblazers, paying flu and PPV claims
based on payment localities. Providers will be
giving the shots throughout the country and transmitting
the claims to Trailblazers for processing.
NOTE: Effective October, 2000 for carrier claims.
DB2 ALIAS: CLM_DEMO_ID_NUM
SAS ALIAS: DEMONUM
STANDARD ALIAS: CLM_DEMO_ID_NUM
TITLE ALIAS: DEMO_ID
SOURCE:
CWF
