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
