NAME:         	Claim Medicare Non Payment Reason Code
 
 
 DESCRIPTION:	The reason that no Medicare payment is made for
 		services on an institutional claim.
  
 
 SHORT NAME: 	NOPAY_CD

 LONG NAME: 	CLM_MDCR_NON_PMT_RSN_CD

 TYPE:		CHAR

 LENGTH: 	2

 SOURCE:	-

 
 CODE VALUES: 	A  = 	Covered worker's compensation (Obsolete)
 
		B  = 	Benefit exhausted
 
		C  = 	Custodial care - noncovered care (includes all 'beneficiary at fault'
			  waiver cases) (Obsolete)
 
		E  = 	HMO out-of-plan services not emergency or urgently needed (Obsolete)
 
		E  = 	MSP cost avoided - IRS/SSA/HCFA Data Match (eff. 7/00)
 
		F  = 	MSP cost avoid HMO Rate Cell (eff. 7/00)
 
		G  = 	MSP cost avoided Litigation Settlement (eff. 7/00)
 
		H  = 	MSP cost avoided Employer Voluntary Reporting (eff. 7/00)
 
		J  = 	MSP cost avoid Insurer Voluntary Reporting (eff. 7/00)
 
		K  = 	MSP cost avoid Initial Enrollment Questionnaire (eff. 7/00)
 
		N  = 	All other reasons for non-payment
 
		P  = 	Payment requested
 
		Q  = 	MSP cost avoided Voluntary Agreement (eff. 7/00)
 
		R  = 	Benefits refused, or evidence not submitted
 
		T  =	MSP cost avoided - IEQ contractor (eff. 9/76) (obsolete 6/30/00)
 
		U  = 	MSP cost avoided - HMO rate cell adjustment (eff. 9/76) (Obsolete 
			  6/30/00)
 
		V  =	MSP cost avoided - litigation settlement (eff. 9/76) (Obsolete 6/30/00)
 
		W  =	Worker's compensation (Obsolete)
 
		X  = 	MSP cost avoided - generic

		Y  = 	MSP cost avoided - IRS/SSA data match project (obsolete 6/30/00)
 
		Z  = 	Zero reimbursement RAPs -- zero reimbursement made due to medical 
			  review intervention or where provider specific zero payment has 
			  been determined. (effective with HHPPS - 10/00) 



		00 	MSP cost avoided - COB Contractor
 
		12 	MSP cost avoided - BCBS Voluntary Agreements
 
		13 	MSP cost avoided - Office of Personnel Management
 
		14 	MSP cost avoided - Workman's Compensation (WC) Datamatch
 
		15 	MSP cost avoided - Workman's Compensation Insurer Voluntary Data 
			  Sharing Agreements (WC VDSA) (eff. 4/2006)
 
		16 	MSP cost avoided - Liability Insurer VDSA (eff. 4/2006)
 
		17 	MSP cost avoided - No-Fault Insurer VDSA (eff. 4/2006)
 
		18 	MSP cost avoided - Pharmacy Benefit Manager Data Sharing Agreement 
			  (eff. 4/2006)
 
		19 	SEE NOTE4: Coordination of Benefits Contractor 11119 (see CMS Change 
			  Request 7906 for identification of the contractor.)
 
		21 	MSP cost avoided - MIR Group Heqalth Plan (eff. 1/2009)
 
		22 	MSP cost avoided - MIR non-Group Health Plan (eff. 1/2009)
 
		25 	MSP cost avoided - Recovery Audit Contractor - California (eff. 10/2005)
 
		26 	MSP cost avoided - Recovery Audit Contractor - Florida (eff. 10/2005)
 
		42 	SEE NOTE4: Coordination of Benefits Contractor 11142 (see CMS Change 
			  Request 7906 for identification of the contractor.)
 
		43 	SEE NOTE4: Coordination of Benefits Contractor 11143 (see CMS Change 
			  Request 7906 for identification of the contractor.)
 

		Effective 4/1/02, the Medicare nonpayment reason code was expanded to a 2-byte 
		field.  The NCH instituted a crosswalk from the 2-byte code to a 1-byte character 
		code.  Below are the character codes (found in NCH & NMUD).  At some point, NMUD 
		will carry the 2-byte code but NCH will continue to have the 1-byte character code.

		! 	MSP cost avoided - COB Contractor ('00' 2-byte code)
 
		@ 	MSP cost avoided - BC/BS Voluntary Agreements ('12' 2-byte code)
 
		# 	MSP cost avoided - Office of Personnel Management ('13' 2-byte code)
 
		$ 	MSP cost avoided - Workman's Compensation (WC) Datamatch ('14' 2-byte code)
 
		* 	MSP cost avoided - Workman's Compensation Insurer Voluntary Data Sharing 
			  Agreements (WC VDSA) ('15' 2-byte code) (eff. 4/2006)
 
		( 	MSP cost avoided - Liability Insurer VDSA ('16' 2-byte code) (eff. 4/2006) 

		) 	MSP cost avoided - No-Fault Insurer VDSA ('17' 2-byte code) (eff. 4/2006)

		+ 	MSP cost avoided - Pharmacy Benefit Manager Data Sharing Agreement ('18' 
			  2-byte code) (eff. 4/2006) 

		< 	MSP cost avoided - MIR Group Health Plan ('21' 2-byte code) (eff. 1/2009)
 
		> 	MSP cost avoided - MIR non-Group Health Plan ('22' 2-byte code) (eff. 1/2009)
 
		% 	MSP cost avoided - Recovery Audit Contractor - California ('25' 2-byte code) 
			  (eff. 10/2005) 

		& 	MSP cost avoided - Recovery Audit Contractor - Florida ('26' 2-byte code) 
			  (eff. 10/2005) 


 COMMENT:	NOTE1:  This field was put on all institutional claim types but data did 
		not start coming in on OP/HHA/Hospice until 4/1/02.  Prior to 4/1/02, data 
		only came in Inpatient/SNF claims.
 
 		NOTE2:  Effective 4/1/02, this field was also expanded to two bytes to 
		accommodate new values. The NCH Nearline file did not expand the current
 		1-byte field but instituted a crosswalk of the 2-byte field to the 1-byte 
		character value. See table of code for the crosswalk.
 
 		NOTE3:  Effective with Version 'J', the field has been expanded on the NCH 
		claim to 2 bytes.   With this expansion the NCH will no longer use the 
		character values to represent the official two byte values being sent in by 
		CWF since 4/2002.
 
 		During the Version 'J' conversion, all character values were converted to the 
		two byte values.