PC069

Data Element

Member Total Out of Pocket Amount

Description

The sum of the copay, coinsurance, and deductible representing the total amount the member is responsible to pay to the provider as part of their costs for services on this claim. This is a money field containing dollars and cents. Code decimal point. This field may contain a negative value. $0.00 is a valid value.

If this field is changed in the versioning process and the dollars must be voided or backed out, the value should be represented as a negative.

TypeNumeric
Format

±decimal

Length10,2
Threshold98%
RequiredRequired
Tip / Notes
Rank064