What is an occurrence code on a claim?

Occurrence Codes identify a significant event relating to an institutional claim that may affect payer processing. These codes are claim-related occurrences that are related to a time period (span of dates).

What is claim frequency type code?

The third digit of the type of bill (TOB3) submitted on an institutional claim record to indicate the sequence of a claim in the beneficiary’s current episode of care. This field can be used in determining the “type of bill” for an institutional claim.

What is a condition code 21?

Condition code 21 indicates services are noncovered, but you are requesting a denial notice in order to bill another insurance or payer source. These claims are sometimes called “no-pay bills” because they are submitted with only noncovered charges on them.

What is an occurrence code 24?

Accident/Medical Payment Coverage – Date of accident/injury for which there is medical payment coverage. If filing for a Conditional Payment, report with Occurrence Code 24. 02. No-Fault Insurance (including automobile and other accidents) – Date of accident/injury for which the state has applicable No-Fault laws.

What is a 50 occurrence code?

Occurrence Code 50: Assessment Date Definition: Code indicating an assessment date as defined by the assessment instrument applicable to this provider type (e.g. Minimum Data Set (MDS) for skilled nursing). (For IRFs, this is the date assessment data was transmitted to the CMS National Assessment Collection Database).

What is the difference between a corrected claim and a replacement claim?

A corrected or replacement claim is a replacement of a previously submitted claim (e.g., changes or corrections to charges, clinical or procedure codes, dates of service, member information, etc.). The new claim will be considered as a replacement of a previously processed claim.

What is condition code 30 and what is it used for?

Condition Code 30 means “Qualified Clinical Trial”. It must appear on the hospital inpatient or outpatient claim when billing for items/services related to a Qualified Clinical Trial or qualified study regardless of whether all services on the claim are related to the clinical trial or not.