BARADJRD ; IHS/SD/LSL - data values for BARADJRA ;
;;1.8;IHS ACCOUNTS RECEIVABLE;;OCT 26, 2005
;
; IHS/SD/LSL - 10/07/2003 - V1.7 Patch 4
; Contains $T values for BARADJRA in regards to NON PAYMENT
;
; *********************************************************************
; ;; IEN ;; DESCRIPTION ;; CATEGORY POINTER
; *********************************************************************
;
NONPYMT ;
;;623;;Pymt Adj Chrgs Pd by Diff Pyr;;4
;;624;;Pymt Adj Chrgs Covrd Capit Agr;;4
;;625;;Pymt Den StopLoss Ded Not Met;;4
;;626;;Expnse Incrrd Prior to Coverag;;4
;;627;;Expnse Incrrd Aft Cov Termnatd;;4
;;628;;Coverage Not in Effect on DOS;;4
;;134;;Time Limit for Filing Expired;;4
;;630;;Pymt Adj Pt Not Met Requiremts;;4
;;166;;Clm Den Pt Not Identifd Isurd;;4
;;632;;Records Indicate Dep Not Elig;;4
;;633;;Clm DenInsured No Depend Cove;;4
;;17;;Clm Den Insured no Cov for NB;;4
;;167;;Benefit Maximum Reached;;4
;;636;;Bal does not Exceed CoPymt Amt;;4
;;637;;Bal Does not Exceed Deductible;;4
;;638;;Serv Not Auth by Designtd Prov;;4
;;639;;Srvcs Den At Time Auth Rqsted;;4
;;640;;Chrgs DoNotMeet Criteria ER/UC;;4
;;168;;Disc Agrmt Pref Prov contract;;4
;;21;;Chrgs Excd Max Allowable Amt;;4
;;643;;Gramm-Rudman Reduction;;4
;;644;;Prompt Pay Discount;;4
;;645;;Chrgs Excd Contrct Fee Arrngmt;;4
;;122;;Services Not Covered;;4
;;648;;Proc Not Covered;;4
;;20;;Non Cov Srv Routine Exam;;4
;;169;;Non Cov Srv Not Medically Nec;;4
;;19;;NonCov Srv Preexsting Cndition;;4
;;178;;Prov Not Elig to Prov Serv Bil;;4
;;653;;Serv by Mbr of Hshld Not Cover;;4
;;654;;Mult Prov Not Cov in This Case;;4
;;659;;Chrgs Adj Mult Surg Anesth Rul;;4
;;660;;Chrgs Outpt Serv Not Covered;;4
;;667;;Lifetime Reserve Days;;4
;;669;;Day Outlier Amount;;4
;;670;;Cost Outlr Adj to CompAdd Cost;;4
;;165;;Primary Payer Amount;;4
;;673;;Administrative Days;;4
;;674;;Indirect Medical Educ Adj;;4
;;675;;Direct Medical Educ Adj;;4
;;676;;Disproportionate Share Adj;;4
;;677;;Covered Days;;4
;;678;;Non Covered Days/Room Chrg Adj;;4
;;679;;Cost Report Days;;4
;;680;;Outlier Days;;4
;;681;;Discharges;;4
;;682;;PIP Days;;4
;;683;;Total Visits;;4
;;684;;Capital Adjustment;;4
;;685;;Interest Amount;;4
;;686;;Statutory Adjustment;;4
;;687;;Transfer Amount;;4
;;689;;Pro Fees Removed From Charges;;4
;;690;;Ingredient Cost Adj;;4
;;695;;Ben Adj Plan Proc Not Followed;;4
;;696;;Non-covered Charge(s);;4
;;697;;Pymt IncludeAllow for Diff Srv;;4
;;699;;MSP Adjustment Amount;;4
;;23;;Pymt Made to Pt/Insrd/Rsp Prty;;4
;;702;;Major Medical Adjustment;;4
;;703;;Provider Promotional Discount;;4
;;704;;Managed Care Withholding;;4
;;705;;Tax Withholding;;4
;;706;;Pt Pymt Optn/Elect Not inEffct;;4
;;708;;Pymt Reduce-Guidelines Not Met;;4
;;709;;Clm not Covered by Payer;;4
;;711;;Not Cov Unlss Prov Acpts Asnmt;;4
;;180;;Pymt Adj Not Furn or Prov toPT;;4
;;713;;Pymt Den Srv Prov Outside US;;4
;;714;;Proc/Src Not approved by FDA;;4
;;715;;Pymt Adj Proc Postponed Cancel;;4
;;716;;Pyt Den Adv Indmn Ntc NotCmply;;4
;;717;;Pymt Adj Transp Covrd CloseFac;;4
;;718;;Charges Redcd for ESRD Support;;4
;;719;;Max Benefits for Time Period;;4
;;720;;Pt Cov'd by Managed Care Plan;;4
;;721;;Indemnification Adjustment;;4
;;722;;Psychiatric Reduction;;4
;;728;;NB Srvc Cov'd in Mothers Allow;;4
;;164;;Pymt Den Prior Info Incorrect;;4
;;730;;Claim Submission Fee;;4
;;731;;Clm Specific Negotiated Disct;;4
;;732;;Pre-Arranged Demo Proj Adj;;4
;;734;;Tech Fees Removed From Charges;;4
;;735;;Clm Den Intrm bill Cannot Proc;;4
;;736;;Clm Adj Plan Proc Prior Payer;;4
;;141;;Pymt/Red for Req charges/taxes;;4
;;738;;Clm Den Appeal Proc Not Follow;;4
;;739;;Contracted funding Agreement;;4
;;125;;Clm Adj Spans Elig/Inelig Date;;4
;;742;;Clm Adj Mnth Medcd Pt Liab Amt;;4
;;744;;Incentive Adjustment;;4
;;801;;Claim Denied Charges;;4
;;802;;Contractual Adjustment;;4
;;803;;MSP Liability Met;;4
;;804;;Medicare Claim PPS Day Outlier;;4
;;805;;Medicare Claim PPS CostOutlier;;4
;;806;;PriorHosp 30day transf not met;;4
;;807;;Presumptive pymt adjustment;;4
;;808;;Clm Den Ungroupable DRG;;4
;;851;;Non-Covered Visits;;4
;;852;;Covered Visits;;4
;;853;;Covered Charges;;4
;;855;;Pymt Adj Guidelines Not Met;;4
;;856;;Pymt Adj Due to Type of Prvder;;4
;;857;;Prov Not Certified for Proc;;4
;;858;;Clm Not Covd Altrnt Serv Avail;;4
;;859;;Srvc Not Covd Pt Enrll Hospice;;4
;;860;;Amt Reduced Portion of Proc pd;;4
;;861;;Clm transfer to proper payer;;4
;;864;;Pymt Den 1 Vt Per Prov Per Day;;4
;;865;;Pymt Adj Proc Not Pd Separate;;4
;;867;;Adj Not Prescr by MD,RX Incmpl;;4
;;869;;Clm Adj Post Rev Org Finding;;4
;;870;;PymtAdj Proc Prtly by DiffProv;;4
;;871;;ChrgRdc Proc Prtly by DiffProv;;4
;;915;;ClmLacks Indctn Srv Sprvs byMD;;4
;;END
BARADJRD ; IHS/SD/LSL - data values for BARADJRA ;
+1 ;;1.8;IHS ACCOUNTS RECEIVABLE;;OCT 26, 2005
+2 ;
+3 ; IHS/SD/LSL - 10/07/2003 - V1.7 Patch 4
+4 ; Contains $T values for BARADJRA in regards to NON PAYMENT
+5 ;
+6 ; *********************************************************************
+7 ; ;; IEN ;; DESCRIPTION ;; CATEGORY POINTER
+8 ; *********************************************************************
+9 ;
NONPYMT ;
+1 ;;623;;Pymt Adj Chrgs Pd by Diff Pyr;;4
+2 ;;624;;Pymt Adj Chrgs Covrd Capit Agr;;4
+3 ;;625;;Pymt Den StopLoss Ded Not Met;;4
+4 ;;626;;Expnse Incrrd Prior to Coverag;;4
+5 ;;627;;Expnse Incrrd Aft Cov Termnatd;;4
+6 ;;628;;Coverage Not in Effect on DOS;;4
+7 ;;134;;Time Limit for Filing Expired;;4
+8 ;;630;;Pymt Adj Pt Not Met Requiremts;;4
+9 ;;166;;Clm Den Pt Not Identifd Isurd;;4
+10 ;;632;;Records Indicate Dep Not Elig;;4
+11 ;;633;;Clm DenInsured No Depend Cove;;4
+12 ;;17;;Clm Den Insured no Cov for NB;;4
+13 ;;167;;Benefit Maximum Reached;;4
+14 ;;636;;Bal does not Exceed CoPymt Amt;;4
+15 ;;637;;Bal Does not Exceed Deductible;;4
+16 ;;638;;Serv Not Auth by Designtd Prov;;4
+17 ;;639;;Srvcs Den At Time Auth Rqsted;;4
+18 ;;640;;Chrgs DoNotMeet Criteria ER/UC;;4
+19 ;;168;;Disc Agrmt Pref Prov contract;;4
+20 ;;21;;Chrgs Excd Max Allowable Amt;;4
+21 ;;643;;Gramm-Rudman Reduction;;4
+22 ;;644;;Prompt Pay Discount;;4
+23 ;;645;;Chrgs Excd Contrct Fee Arrngmt;;4
+24 ;;122;;Services Not Covered;;4
+25 ;;648;;Proc Not Covered;;4
+26 ;;20;;Non Cov Srv Routine Exam;;4
+27 ;;169;;Non Cov Srv Not Medically Nec;;4
+28 ;;19;;NonCov Srv Preexsting Cndition;;4
+29 ;;178;;Prov Not Elig to Prov Serv Bil;;4
+30 ;;653;;Serv by Mbr of Hshld Not Cover;;4
+31 ;;654;;Mult Prov Not Cov in This Case;;4
+32 ;;659;;Chrgs Adj Mult Surg Anesth Rul;;4
+33 ;;660;;Chrgs Outpt Serv Not Covered;;4
+34 ;;667;;Lifetime Reserve Days;;4
+35 ;;669;;Day Outlier Amount;;4
+36 ;;670;;Cost Outlr Adj to CompAdd Cost;;4
+37 ;;165;;Primary Payer Amount;;4
+38 ;;673;;Administrative Days;;4
+39 ;;674;;Indirect Medical Educ Adj;;4
+40 ;;675;;Direct Medical Educ Adj;;4
+41 ;;676;;Disproportionate Share Adj;;4
+42 ;;677;;Covered Days;;4
+43 ;;678;;Non Covered Days/Room Chrg Adj;;4
+44 ;;679;;Cost Report Days;;4
+45 ;;680;;Outlier Days;;4
+46 ;;681;;Discharges;;4
+47 ;;682;;PIP Days;;4
+48 ;;683;;Total Visits;;4
+49 ;;684;;Capital Adjustment;;4
+50 ;;685;;Interest Amount;;4
+51 ;;686;;Statutory Adjustment;;4
+52 ;;687;;Transfer Amount;;4
+53 ;;689;;Pro Fees Removed From Charges;;4
+54 ;;690;;Ingredient Cost Adj;;4
+55 ;;695;;Ben Adj Plan Proc Not Followed;;4
+56 ;;696;;Non-covered Charge(s);;4
+57 ;;697;;Pymt IncludeAllow for Diff Srv;;4
+58 ;;699;;MSP Adjustment Amount;;4
+59 ;;23;;Pymt Made to Pt/Insrd/Rsp Prty;;4
+60 ;;702;;Major Medical Adjustment;;4
+61 ;;703;;Provider Promotional Discount;;4
+62 ;;704;;Managed Care Withholding;;4
+63 ;;705;;Tax Withholding;;4
+64 ;;706;;Pt Pymt Optn/Elect Not inEffct;;4
+65 ;;708;;Pymt Reduce-Guidelines Not Met;;4
+66 ;;709;;Clm not Covered by Payer;;4
+67 ;;711;;Not Cov Unlss Prov Acpts Asnmt;;4
+68 ;;180;;Pymt Adj Not Furn or Prov toPT;;4
+69 ;;713;;Pymt Den Srv Prov Outside US;;4
+70 ;;714;;Proc/Src Not approved by FDA;;4
+71 ;;715;;Pymt Adj Proc Postponed Cancel;;4
+72 ;;716;;Pyt Den Adv Indmn Ntc NotCmply;;4
+73 ;;717;;Pymt Adj Transp Covrd CloseFac;;4
+74 ;;718;;Charges Redcd for ESRD Support;;4
+75 ;;719;;Max Benefits for Time Period;;4
+76 ;;720;;Pt Cov'd by Managed Care Plan;;4
+77 ;;721;;Indemnification Adjustment;;4
+78 ;;722;;Psychiatric Reduction;;4
+79 ;;728;;NB Srvc Cov'd in Mothers Allow;;4
+80 ;;164;;Pymt Den Prior Info Incorrect;;4
+81 ;;730;;Claim Submission Fee;;4
+82 ;;731;;Clm Specific Negotiated Disct;;4
+83 ;;732;;Pre-Arranged Demo Proj Adj;;4
+84 ;;734;;Tech Fees Removed From Charges;;4
+85 ;;735;;Clm Den Intrm bill Cannot Proc;;4
+86 ;;736;;Clm Adj Plan Proc Prior Payer;;4
+87 ;;141;;Pymt/Red for Req charges/taxes;;4
+88 ;;738;;Clm Den Appeal Proc Not Follow;;4
+89 ;;739;;Contracted funding Agreement;;4
+90 ;;125;;Clm Adj Spans Elig/Inelig Date;;4
+91 ;;742;;Clm Adj Mnth Medcd Pt Liab Amt;;4
+92 ;;744;;Incentive Adjustment;;4
+93 ;;801;;Claim Denied Charges;;4
+94 ;;802;;Contractual Adjustment;;4
+95 ;;803;;MSP Liability Met;;4
+96 ;;804;;Medicare Claim PPS Day Outlier;;4
+97 ;;805;;Medicare Claim PPS CostOutlier;;4
+98 ;;806;;PriorHosp 30day transf not met;;4
+99 ;;807;;Presumptive pymt adjustment;;4
+100 ;;808;;Clm Den Ungroupable DRG;;4
+101 ;;851;;Non-Covered Visits;;4
+102 ;;852;;Covered Visits;;4
+103 ;;853;;Covered Charges;;4
+104 ;;855;;Pymt Adj Guidelines Not Met;;4
+105 ;;856;;Pymt Adj Due to Type of Prvder;;4
+106 ;;857;;Prov Not Certified for Proc;;4
+107 ;;858;;Clm Not Covd Altrnt Serv Avail;;4
+108 ;;859;;Srvc Not Covd Pt Enrll Hospice;;4
+109 ;;860;;Amt Reduced Portion of Proc pd;;4
+110 ;;861;;Clm transfer to proper payer;;4
+111 ;;864;;Pymt Den 1 Vt Per Prov Per Day;;4
+112 ;;865;;Pymt Adj Proc Not Pd Separate;;4
+113 ;;867;;Adj Not Prescr by MD,RX Incmpl;;4
+114 ;;869;;Clm Adj Post Rev Org Finding;;4
+115 ;;870;;PymtAdj Proc Prtly by DiffProv;;4
+116 ;;871;;ChrgRdc Proc Prtly by DiffProv;;4
+117 ;;915;;ClmLacks Indctn Srv Sprvs byMD;;4
+118 ;;END
