This variable is contained in the following files: Carrier (Fee-for-Service), Durable Medical Equipment (Fee-for-Service)
Short SAS Name
LINE_OTHR_APLD_IND_CD5
SAS Name
LINE_OTHR_APLD_IND_CD5

The code used to identify the reason the claim payment amount was adjusted during claims processing.

Comments
: 

See the associated amounts in the LINE_OTHR_APLD_AMT{#} field.

There are up to 7 of these line applied indicator fields (LINE_OTHR_APLD_IND_CD1 - LINE_OTHR_APLD_IND_CD7).

Source: NCH

 

CodeCode value
A
Gramm-Rudman reduction required for services (03/03/1986-09/30/1986)
B
Interest addition
C
Positive rounding adjustment (due to line item distribution from total claim reimbursement amount)
D
Negative rounding adjustment (due to line item distribution from total claim reimbursement amount)
E
Primary Payer allowed charge
F
Good cause
G
PMD Demonstration Reduction
H
Sequestration Reduction Amount
I
eRX Negative Adjustment Reduction Amount
J
ACO Payment Adjustment Amount (Pioneer ACO Reduction) - eff. 1/2014
K
ASC Quality Reporting Payment Reduction (eff. 1/2014)
L
ACO Payment Adjustment Amount (Pioneer reduction) - the actual amount of the Pioneer reduction. (eff. 1/2014)
M
Physician Quality Reporting System (PQRS) Negative Payment Adjustment – eff. 1/2015
N
None
O
Value Modifier Payment Adjustment – eff. 1/2015
P
VBM Positive Payment Adjustment
Q
Electronic Health Record (EHR) Negative Payment Adjustment – eff. 1/2015
S
Prior Authorization Reduction (eff. 10/2016)
T
Comprehensive Primary Care Plus (CPC+) Payment Adjustment (eff. 4/2017)
U
Maryland Primary Care Program (MDPCP) Reduction – eff. 1/2018
V
Positive Amount for Quality Payment Program (QPP) payment adjustment – eff. 1/2018
W
Negative Amount for Quality Payment Program (QPP) payment adjustment – eff. 1/2018