AMOUNT OF MONEY PAID BY MEDICAID (PREMIUM PAYMENTS TO PREPAID PLANS) FOR THE RECIPIENT DURING THE CALENDAR YEAR, FOR TYPES OF SERVICE = 20-23.
(SAS USERS: ZONED DECIMAL - ZD8)
Comments
USER NOTE: RECORDS WITH TYPES OF SERVICE = 20-23 SHOULD HAVE TYPE OF CLAIM = 2 (CAPITATED PAYMENT). IF NOT, IT IS MORE LIKELY THAT TYPE OFSERVICE IS CORRECT. SO, WE COUNT RECORDS HERE WITH TYPES OF SERVICE = 20-23 AND ANY VALUE FOR TYPE OF CLAIM. ALSO, ENCOUNTER RECORDS (TYPEOF CLAIM = 3) HAVE $0 PAYMENT AMOUNTS.
USER NOTE: RECORDS WITH TYPES OF SERVICE = 20-23 SHOULD HAVE TYPE OF CLAIM = 2 (CAPITATED PAYMENT). IF NOT, IT IS MORE LIKELY THAT TYPE OFSERVICE IS CORRECT. SO, WE COUNT RECORDS HERE WITH TYPES OF SERVICE = 20-23 AND ANY VALUE FOR TYPE OF CLAIM. ALSO, ENCOUNTER RECORDS (TYPEOF CLAIM = 3) HAVE $0 PAYMENT AMOUNTS.
SOURCE: MSIS CLAIMS FILES.