NAME             TYPE   LENGTH
-------------------------------------   ------
    Claim Payment Amount         NUM     12   

	Amount of payment made from the Medicare trust fund for the
	services covered by the claim record.  Generally, the amount
	is calculated by the FI or carrier; and represents what was
	paid to the institutional provider, physician, or supplier,
	with the exceptions noted below.  **NOTE:  In some
	situations, a negative claim payment amount may be pre-
	sent; e.g., (1) when a beneficiary is charged the full
	deductible during a short stay and the deductible exceeded
	the amount Medicare pays; or (2) when a beneficiary is
	charged a coinsurance amount during a long stay and the
	coinsurance amount exceeds the amount Medicare pays (most
	prevalent situation involves psych hospitals who are paid a
	daily per diem rate no matter what the charges are.)

	Under IP PPS, inpatient hospital services are paid based on
	a predetermined rate per discharge, using the DRG patient
	classification system and the PRICER program.   On the IP
	PPS claim, the payment amount includes the DRG outlier
	approved payment amount, disproportionate share (since
	5/1/86), indirect medical education (since 10/1/88), total
	PPS capital (since 10/1/91).  It does NOT include the pass
	thru amounts (i.e., capital-related costs, direct medical
	education costs, kidney acquisition costs, bad debts); or
	any beneficiary-paid amounts (i.e., deductibles and
	coinsurance); or any other payer reimbursement.

	Under SNF PPS, SNFs will classify beneficiaries using the
	patient classification system known as RUGS III.  For the
	SNF PPS claim, the SNF PRICER will calculate/return the rate
	for each revenue center line item with revenue center code =
	'0022'; multiply the rate times the units count; and then
	sum the amount payable for all lines with revenue center
	code '0022' to determine the total claim payment amount.

	Under Outpatient PPS, the national ambulatory payment
	classification (APC) rate that is calculated for each APC
	group is the basis for determining the total payment.  The
	Medicare payment amount takes into account the wage index
	adjustment and the beneficiary deductible and coinsurance
	amounts.  NOTE: There is no CWF edit check to validate that
	the revenue center Medicare payment amount equals the claim
	level Medicare payment amount.

	Under Home Health PPS, beneficiaries will be classified into
	an appropriate case mix category known as the Home Health
	Resource Group.  A HIPPS code is then generated
	corresponding to the case mix category (HHRG).

	For the RAP, the PRICER will determine the payment amount
	appropriate to the HIPPS code by computing 60% (for first
	episode) or 50% (for subsequent episodes) of the case mix
	episode payment.  The payment is then wage index adjusted.

	For the final claim, PRICER calculates 100% of the amount
	due, because the final claim is processed as an adjustment
	to the RAP, reversing the RAP payment in full.  Although
	final claim will show 100% payment amount, the provider will
	actually receive the 40% or 50% payment.

	Exceptions:  For claims involving demos and BBA encounter
	data, the amount reported in this field may not just
	represent the actual provider payment.

	    For demo Ids '01','02','03','04' -- claims contain
	    amount paid to the provider, except that special
	    'differentials' paid outside the normal payment system
	    are not included.

	    For demo Ids '05','15' -- encounter data 'claims'
	    contain amount Medicare would have paid under FFS,
	    instead of the actual payment to the MCO.

	    For demo Ids '06','07','08' -- claims contain actual
	    provider payment but represent a special negotiated
	    bundled payment for both Part A and Part B services.
	    To identify what the conventional provider Part A
	    payment would have been, check value code = 'Y4'.   The
	    related noninstitutional (physician/supplier) claims
	    contain what would have been paid had there been no
	    demo.

	    For BBA encounter data (non-demo) -- 'claims' contain
	    amount Medicare would have paid under FFS, instead of
	    the actual payment to the BBA plan.


	9.2 DIGITS SIGNED

	SHORT NAME: PMT_AMT
	LONG NAME: CLM_PMT_AMT

	EDIT-RULES:
	$$$$$$$$$CC

	COMMENT:
	Prior to Version H the size of this field was S9(7)V99.  Als
	the noninstitutional claim records carried this field as a l
	item.  Effective with Version H, this element is a claim lev
	field across all claim types (and the line item field has be
	renamed.)

	SOURCE:
	CWF

	LIMITATIONS:
	Prior to 4/6/93, on inpatient, outpatient, and
	physician/supplier claims containing a
	CLM_DISP_CD of '02', the amount shown as the Medicare
	reimbursement does not take into consideration
	any CWF automatic adjustments (involving erroneous
	deductibles in most cases).  In as many as 30% of
	the claims (30% IP, 15% OP, 5% PART B), the
	reimbursement reported on the claims may be over
	or under the actual Medicare payment amount.