Flag 3 - Discounting Formula Number

Discounting Formula Number 

‘D’ Discounting Fraction (currently 0.5) 

‘U’ Number of Units 

‘T’  Terminated Procedure Discount (currently 0.5) 

Value Description 

1          1.0  

2          (1.0+D(U-1))/U 

3          T/U 

4         (1+D)/U 

5            D 

6         TD/U 

7            D(1+D)/U

8            2.0 

Flag 4 – Line Item Denial of Rejection

Value Description 

1        Line item not denied or rejected 

 2       Line item denied or rejected (procedure edit return buffer for line item contains a ‘9’, ‘13’, ‘18’, ‘19’, ‘20’, ‘21’, ‘28’, ‘39’, ‘40’, ‘45’, ‘47’ ,’49’, ‘50’, ‘53’, ‘64’) 

3          Not in Use

Flag 5 – Packaging

Value Description 

0      Not packaged 

1      Packaged service (status indicator ‘N’ or no HCPCS code and certain revenue codes) 

2      Packaged as part of partial hospitalization Per Diem or daily mental health service Per Diem