NAME              TYPE   LENGTH
------------------------------------   ------
8. NCH Claim Type Code          CHAR      2

The code used to identify the type of claim record being
processed in NCH.


NOTE1:  During the Version H conversion this field was
        populated with data through- out history (back to
        service year 1991).
NOTE2:  During the Version I conversion this field was
        expanded to include inpatient 'full' encounter
        claims (for service dates after 6/30/97).
        Placeholders for Physician and Outpatient encounters
        (available in NMUD) have also been added.

DB2 ALIAS: NCH_CLM_TYPE_CD
SAS ALIAS: CLM_TYPE
STANDARD ALIAS: NCH_CLM_TYPE_CD
SYSTEM ALIAS: LTTYPE
TITLE ALIAS: CLAIM_TYPE

DERIVATION:
FFS CLAIM TYPE CODES DERIVED FROM:
  NCH CLM_NEAR_LINE_RIC_CD
  NCH PMT_EDIT_RIC_CD
  NCH CLM_TRANS_CD
  NCH PRVDR_NUM

INPATIENT 'FULL' ENCOUNTER TYPE CODE DERIVED FROM:
  (Pre-HDC processing -- AVAILABLE IN NCH)
  CLM_MCO_PD_SW
  CLM_RLT_COND_CD
  MCO_CNTRCT_NUM
  MCO_OPTN_CD
  MCO_PRD_EFCTV_DT
  MCO_PRD_TRMNTN_DT

INPATIENT 'FULL' ENCOUNTER TYPE CODE DERIVED FROM:
  (HDC processing -- AVAILABLE IN NMUD)
  FI_NUM

INPATIENT 'ABBREVIATED' ENCOUNTER TYPE CODE DERIVED
FROM: (HDC processing -- AVAILABLE IN NMUD)
  FI_NUM
  CLM_FAC_TYPE_CD
  CLM_SRVC_CLSFCTN_TYPE_CD
  CLM_FREQ_CD
NOTE:  From 7/1/97 to the start of HDC processing(?),
abbreviated inpatient encounter claims are not
available in NCH or NMUD.

PHYSICIAN 'FULL' ENCOUNTER TYPE CODE DERIVED FROM:
  (AVAILABLE IN NMUD)
  CARR_NUM
  CLM_DEMO_ID_NUM

OUTPATIENT 'FULL' ENCOUNTER TYPE CODE DERIVED FROM:
  (AVAILABLE IN NMUD)
  FI_NUM

OUTPATIENT 'ABBREVIATED' ENCOUNTER TYPE CODE
DERIVED FROM:  (AVAILABLE IN NMUD)
  FI_NUM
  CLM_FAC_TYPE_CD
  CLM_SRVC_CLSFCTN_TYPE_CD
  CLM_FREQ_CD

DERIVATION RULES:

  SET CLM_TYPE_CD TO 10 (HHA CLAIM) WHERE THE
  FOLLOWING CONDITIONS ARE MET:
  1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V','W' OR 'U'
  2.   PMT_EDIT_RIC_CD EQUAL 'F'
  3.   CLM_TRANS_CD EQUAL '5'

  SET CLM_TYPE_CD TO 20 (SNF NON-SWING BED CLAIM)
  WHERE THE FOLLOWING CONDITIONS ARE MET:
  1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V'
  2.   PMT_EDIT_RIC_CD EQUAL 'C' OR 'E'
  3.   CLM_TRANS_CD EQUAL '0' OR '4'
  4.   POSITION 3 OF PRVDR_NUM IS NOT 'U', 'W', 'Y'
       OR 'Z'

  SET CLM_TYPE_CD TO 30 (SNF SWING BED CLAIM)
  WHERE THE FOLLOWING CONDITIONS ARE MET:
  1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V'
  2.   PMT_EDIT_RIC_CD EQUAL 'C' OR 'E'
  3.   CLM_TRANS_CD EQUAL '0' OR '4'
  4.   POSITION 3 OF PRVDR_NUM EQUAL 'U', 'W', 'Y'
       OR 'Z'

  SET CLM_TYPE_CD TO 40 (OUTPATIENT CLAIM)
  WHERE THE FOLLOWING CONDITIONS ARE MET:
  1.   CLM_NEAR_LINE_RIC_CD EQUAL 'W'
  2.   PMT_EDIT_RIC_CD EQUAL 'D'
  3.   CLM_TRANS_CD EQUAL '6'

  SET CLM_TYPE_CD TO 41 (OUTPATIENT 'FULL'
  ENCOUNTER CLAIM -- AVAILABLE IN NMUD) WHERE
  THE FOLLOWING CONDITIONS ARE MET:
  1.   CLM_NEAR_LINE_RIC_CD EQUAL 'W'
  2.   PMT_EDIT_RIC_CD EQUAL 'D'
  3.   CLM_TRANS_CD EQUAL '6'
  4.   FI_NUM = 80881

  SET CLM_TYPE_CD TO 42 (OUTPATIENT 'ABBREVIATED'
  ENCOUNTER CLAIMS -- AVAILABLE IN NMUD)
  1.   FI_NUM = 80881
  2.   CLM_FAC_TYPE_CD = '1' OR '8'; CLM_SRVC_
       CLSFCTN_TYPE_CD = '2', '3' OR '4' &
       CLM_FREQ_CD = 'Z', 'Y' OR 'X'

  SET CLM_TYPE_CD TO 50 (HOSPICE CLAIM)
  WHERE THE FOLLOWING CONDITIONS ARE MET:
  1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V'
  2.   PMT_EDIT_RIC_CD EQUAL 'I'
  3.   CLM_TRANS_CD EQUAL 'H'

  SET CLM_TYPE_CD TO 60 (INPATIENT CLAIM)
  WHERE THE FOLLOWING CONDITIONS ARE MET:
  1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V'
  2.   PMT_EDIT_RIC_CD EQUAL 'C' OR 'E'
  3.   CLM_TRANS_CD EQUAL '1' '2' OR '3'

  SET CLM_TYPE_CD TO 61 (INPATIENT 'FULL' ENCOUNTER
  CLAIM - PRIOR TO HDC PROCESSING - AFTER 6/30/97 -
  12/4/00) WHERE THE FOLLOWING CONDITIONS ARE MET:
  1.   CLM_MCO_PD_SW = '1'
  2.   CLM_RLT_COND_CD = '04'
  3.   MCO_CNTRCT_NUM
       MCO_OPTN_CD = 'C'
       CLM_FROM_DT & CLM_THRU_DT ARE WITHIN THE
       MCO_PRD_EFCTV_DT & MCO_PRD_TRMNTN_DT
       ENROLLMENT PERIODS

  SET_CLM_TYPE_CD TO 61 (INPATIENT 'FULL' ENCOUNTER
  CLAIM -- EFFECTIVE WITH HDC PROCESSING) WHERE THE
  FOLLOWING CONDITIONS ARE MET:
  1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V'
  2.   PMT_EDIT_RIC_CD EQUAL 'C' OR 'E'
  3.   CLM_TRANS_CD EQUAL '1' '2' OR '3'
  4.   FI_NUM = 80881

  SET CLM_TYPE_CD TO 62 (INPATIENT 'ABBREVIATED'
  ENCOUNTER CLAIM -- AVAILABLE IN NMUD) WHERE
  THE FOLLOWING CONDITIONS ARE MET:
  1.   FI_NUM = 80881 AND
  2.   CLM_FAC_TYPE_CD = '1'; CLM_SRVC_CLSFCTN_
       TYPE_CD = '1'; CLM_FREQ_CD = 'Z'

  SET CLM_TYPE_CD TO 71 (RIC O non-DMEPOS CLAIM)
  WHERE THE FOLLOWING CONDITIONS ARE MET:
  1.   CLM_NEAR_LINE_RIC_CD EQUAL 'O'
  2.   HCPCS_CD not on DMEPOS table

  SET CLM_TYPE_CD TO 72 (RIC O DMEPOS CLAIM)
  WHERE THE FOLLOWING CONDITIONS ARE MET:
  1.   CLM_NEAR_LINE_RIC_CD EQUAL 'O'
  2.   HCPCS_CD on DMEPOS table (NOTE: if one or
        more line item(s) match the HCPCS on the
        DMEPOS table).

  SET CLM_TYPE_CD TO 73 (PHYSICIAN ENCOUNTER CLAIM--
  EFFECTIVE WITH HDC PROCESSING) WHERE THE FOLLOWING
  CONDITIONS ARE MET:
  1.   CARR_NUM = 80882 AND
  2.   CLM_DEMO_ID_NUM = 38

  SET CLM_TYPE_CD TO 81 (RIC M non-DMEPOS DMERC
     CLAIM)
  WHERE THE FOLLOWING CONDITIONS ARE MET:
  1.   CLM_NEAR_LINE_RIC_CD EQUAL 'M'
  2.   HCPCS_CD not on DMEPOS table

  SET CLM_TYPE_CD TO 82 (RIC M DMEPOS DMERC CLAIM)
  WHERE THE FOLLOWING CONDITIONS ARE MET:
  1.   CLM_NEAR_LINE_RIC_CD EQUAL 'M'
  2.   HCPCS_CD on DMEPOS table (NOTE: if one or
        more line item(s) match the HCPCS on the
        DMEPOS table).

CODES:

NCH Claim Type Table
--------------------

10 = HHA claim
20 = Non swing bed SNF claim
30 = Swing bed SNF claim
40 = Outpatient claim
41 = Outpatient 'Full-Encounter' claim
     (available in NMUD)
42 = Outpatient 'Abbreviated-Encounter' claim
     (available in NMUD)
50 = Hospice claim
60 = Inpatient claim
61 = Inpatient 'Full-Encounter' claim
62 = Inpatient 'Abbreviated-Encounter claim
     (available in NMUD)
71 = RIC O local carrier non-DMEPOS claim
72 = RIC O local carrier DMEPOS claim
73 = Physician 'Full-Encounter' claim
     (available in NMUD)
81 = RIC M DMERC non-DMEPOS claim
82 = RIC M DMERC DMEPOS claim

SOURCE:
NCH