Updated research request forms and data security approval requirement effective 4/24/23
This variable is contained in the following files:
SAS Name
CLM_NEXT_GNRTN_ACO_IND_CD5
The field identifies the claims that qualify for specific claims processing edits related to benefit enhancement through the Next Generation (NG) Accountable Care Organization (ACO).
| Code | Code value |
|---|---|
| 0 | Base record (no enhancements) |
| 1 | Population Based Payments (PBP) |
| 2 | Telehealth |
| 3 | Post Discharge Home Health Visits |
| 4 | 3-Day SNF Waiver |
| 5 | Capitation |
| 6 | CEC Telehealth |
| 7 | Care Management Home Visits |
| 8 | Primary Care Capitation (PCC) |
| 9 | Home Health Benefit Enhancement — eff. 4/2021 |
| B | Concurrent Care for Beneficiaries that Elect the Medicare Hospice Benefit — eff. 4/2021 |
| C | Kidney Disease Education (KDE) — eff. 4/2021 |
| D | Seriously Ill Population (SIP) |
| E | Flat Visit Fee (FVF) |
| F | Quarterly Capitation Payment (QCP) — eff. 4/2021 |
| G | Performance Based Adjustment (PBA) — eff. 7/2022 |
These fields were added to the DME claim lines October 2023. The Accountable Care Organization (ACO) Realizing Equity, Access, and Community Health (REACH) Model made changes to expand services to allow for nurse practitioners and physician assistants to certify, order and refer certain Medicare services. Previously, these fields were on the carrier claims (on the line file) and on all institutional claim types (inpatient, SNF, HHA, hospice, and outpatient) at the claim-level. There are five occurrences of this field on a claim (or claim line), but each value can only be represented once. The five occurrences of this field are found at the claim level on all institutional claim types and at the line level on Part B carrier and DME claims.
Source: NCH