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The total payments made to the beneficiary for this claim (sum of all line-level payments to beneficiary, variable called LINE_BENE_PMT_AMT). 

The total payments made to the provider for this claim (sum of line item provider payment amounts (variable called LINE_PRVDR_PMT_AMT).

The type of claim that was submitted. There are different claim types for each major category of health care provider.

On an institutional claim, the additional payment amount approved by the Quality Improvement Organization due to an outlier situation for a beneficiary's stay under the prospective payment system (PPS), which has been classified into a specific diagnosis related group (DRG).

This variable will typically include the total outlier payment amount, if any, for the claim.

The non-covered charges for all accommodations and services, reported on an inpatient claim (used for internal NCHMQA editing purposes). 

The total of all Part A and blood deductibles and coinsurance amounts on the claim.

A code defining the type of claim record being processed.

This variable is a recoded version of the discharge status code (variable called PTNT_DSCHRG_STUS_CD).

The amount of a payment made on behalf of a Medicare beneficiary by a primary payer other than Medicare, that the provider is applying to covered Medicare charges on a non-institutional claim. 

Effective with Version H, the amount of a payment made on behalf of a Medicare bene- ficiary by a primary payer other than Medicare, that the provider is applying to covered Medicare charges on a non-institutional claim.
NOTE: During the Version H conversion, this field was populated with data throughout history (back to service year 1991) by summing up the line item primary payer amounts.

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.

The presence of a primary payer code indicates that some other payer besides Medicare covered at least some portion of the charges.

The two-digit numeric social security administration (SSA) state code where provider or facility is located.

The two-digit numeric social security administration (SSA) state code where provider or facility is located. 

Effective with Version H, the two position SSA state code where provider facility is located.
NOTE: During the Version H conversion this field was populated with data throughout history (back to service year 1991).

The beginning date of the beneficiary's qualifying Medicare stay.

For inpatient claims, the date relates to the PPS portion of the inlier for which there is no utilization of benefits.

For SNF claims, the date relates to a qualifying stay from a hospital that is at least two days in a row if the source of admission is an 'A' (transfer from critical access hospital), or at least three days in a row if the source of admission is other than 'A'.

The ending date of the beneficiary's qualifying Medicare stay.

For inpatient claims, the date relates to the PPS portion of the inlier for which there is no utilization of benefits.

For SNF claims, the date relates to a qualifying stay from a hospital that is at least two days in a row if the source of admission is an 'A' (transfer from critical access hospital), or at least three days in a row if the source of admission is other than 'A'.

The beginning date of the beneficiary's Non-covered stay.

Medicare places limits on the number of days of inpatient or SNF care that a beneficiary may receive.

For some beneficiaries, all days in one of these settings may not be covered by Medicare.

The ending date of the beneficiary's non-covered stay.

Medicare places limits on the number of days of inpatient or SNF care that a beneficiary may receive.

For some beneficiaries, all days in one of these settings may not be covered by Medicare.

The date the weekly NCH database load process cycle begins, during which the claim records are loaded into the Nearline file. This date will always be a Friday, although the claims will actually be appended to the database subsequent to the date.

This is the unique identification number assigned by the National Council for Prescription Drug Programs (NCPDP) to every licensed pharmacy in the United States and its territories.  

This field also enables linkage between pharmacies in the Part D Event (PDE) File and the CCW Pharmacy Characteristics File for 2014+.

This is the unique, national identification number assigned by the National Council for Prescription Drug Programs (NCPDP) to every licensed pharmacy in the United States and its territories.

This field also enables linkage between pharmacies in the Part D Event (PDE) File and the CCW Pharmacy Characteristics File.

NDC

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