Box 31-34 Occurrence Code/Date

  • Updated

Box Definition

The occurrence code and the date field define a significant event associated with the bill that affects processing by the payer (e.g., accident, employment-related, etc.).

The provider enters code(s) and associated date(s) defining specific event(s) relating to this billing period. 


In AveaOffice

To populate Box 31-34, you'll need to select the Occurrence Code and Occurrence Code Date on the Treatment Episode, then configure a claim rule to pull the code and date onto the claim. Note: If this is for a workers comp claim, the patient must also have a Social Security Number added to their Profile tab.

  1. Navigate to Patients and click on the Patient Name.mceclip0__22_.png
  2. Click on the Intake quick link for the treatment episode.mceclip1__13_.png
  3. On the Admit/Discharge tab, click Edit. mceclip0.png
  4. Add or update the Occurrence Code and Occurrence Code Date fields.
  5. Click Save
  6. Next, set up a claim rule for the desired payer. Click here for instructions.
  7. Once the claim rule is configured:
    • The Occurrence Code Date and Cccurrence Code will be added to future institutional claims (pulled from the Admit/Discharge tab of the Treatment Episode). 
    • The Occurrence and Code Occurrence Code Date will be added to the form contents view (in the EDI section)
    • The Occurrence Code and Occurrence Code Date will be added to the Claim Form Preview in Box 31a.

Billing Scenarios

  • Claim Corrections
    • Scenario 1: If the patient is already receiving treatment and they do not have the Occurrence information in their treatment episode, the system will try to generate the corrections but will show them an error saying something to the effect of no occurrence code listed. Please add the Occurrence Code and Occurrence Code Date to the Admit/Discharge tab. Then, generate claim corrections.
    • Scenario 2: If the patient has the Occurrence information in the Admit/Discharge tab before the rule is created and enabled, the system will generate claim corrections automatically.
  • New Claims
    • Scenario 3: If the claim rule has been created but the patient doesn't have the Occurrence information in their profile, you will be able to create new claims but you will receive a system error under the Work Center > Insurance Billing > Submit Claims tab. Update the Occurrence information in the Patient Profile > Treatment Episode > Intake section and then delete the claims from the Submit Claims tab. This will revert the treatments to the Create New Treatments tab where you can re-create the claims again. Upon recreation, the occurrence code and date will be written to the EDI file.
    • Scenario 4: If the claim rule is created and active and the patient has the Occurrence Codea and Occurrence Code Date in their profile when the patient's claims are created and submitted, the occurrence information will be written to the claim automatically.

Important: When you receive a configuration error (e.g., missing occurrence codes) on the Submit Claims tab, the claims with the related error must always be deleted and recreated after the changes have been made. Otherwise, the system won't recognize the issue has been resolved. 

List of Occurrence Codes

The following Occurrence Codes are available for selection when creating the patient's Treatment Episode or updating the Admit/Discharge tab.

1 Accident/Medical Coverage
2 No Fault Insurance Involved - Including Auto Accident/Other
3 Accident/Tort Liability
4 Accident/ Employment Related
5 Accident/No Medical or Liability Coverage
6 Crime Victim
9 Start of Infertility Treatment Cycle
10 Last Menstrual Period
11 Onset of Symptoms/Illness
12 Date of Onset for A Chronically Dependent Individual
16 Date of Last Therapy
17 Date Outpatient Occupational Therapy Plan Established or Last Reviewed
18 Date of Retirement - Patient/Beneficiary
19 Date of Retirement - Spouse
20 Date Guarantee of Payment Began
21 Date Ur Notice Received
22 Date Active Care Ended
23 Payer Code
24 Date Insurance Denied
25 Date Benefits Terminated by Primary Payer
26 Date SNF Bed Became Available
27 Date of Hospice Certification or Recertification
28 Date Comprehensive Outpatient Rehabilitation Plan Established or Last Reviewed
29 Date Outpatient Physical Therapy Plan Established or Last Reviewed
30 Date Outpatient Speech Pathology Plan Established or Last Reviewed
31 Date Beneficiary Notified of Intent to Bill (Accommodations)
32 Date Beneficiary Notified of Intent to Bill (Procedures or Treatments)
33 First Day of The Coordination Period for ESRD Beneficiaries Covered By EGHP
34 Date of Election of Extended Care Facilities
35 Date Treatment Started for Physical Therapy
36 Date of Inpatient Hospital Discharge for Covered Transplant Patient
37 Date of Inpatient Hospital Discharge for Non-Covered Transplant Patient
38 Date Treatment Started for Home IV Therapy
39 Date Discharged on a Continuous Course of IV Therapy
40 Scheduled Date of Admission
41 Date of First Test for Pre-Admission Testing
42 Date of Discharge
43 Scheduled Date of Canceled Surgery
44 Date Treatment Started for Occupational Therapy
45 Date Treatment Started for Speech Therapy
46 Date Treatment Started for Cardiac Rehabilitation
47 Date Cost Outlier Status Begins
48 Payer Code
49 Payer Code
50 Assessment Date (Effective 1/1/11)
51 Date of Last Kt/V Reading (Effective 7/1/10)
52 Medical Certification/Recertification Date (Effective 1/1/11)
54 Physician Follow-Up Date (Effective 1/1/11)
55 Date of Death (Effective 10/1/12)
56 Original Hospice Election or Revocation Date (Effective 1/1/18)
61 Hospital Discharge Date (HHA Only) (Effective 1/1/20)
62 Other Institutional Discharge Date (HHA Only) (Effective 1/1/20)
A1 Birthdate - Insured A
A2 Effective Date - Insured A Policy
A3 Benefits Exhausted - Payer A
A4 Split Bill Date
AA Payer Code
AB Payer Code
AC Payer Code
AD Payer Code
AE Payer Code
AF Payer Code
AG Payer Code
AH Payer Code
AI Payer Code
AJ Payer Code
AK Payer Code
AL Payer Code
AM Payer Code
AN Payer Code
AO Payer Code
AP Payer Code
AQ Payer Code
AR Payer Code
AS Payer Code
AT Payer Code
AU Payer Code
AV Payer Code
AW Payer Code
AX Payer Code
AY Payer Code
AZ Payer Code
B1 Birthdate - Insured B
B2 Effective Date - Insured B Policy
B3 Benefits Exhausted - Payer B
C1 Birthdate - Insured C
C2 Effective Date - Insured C Policy
C3 Benefits Exhausted - Payer C
DR Reserved for Disaster Related Occurrence Code

EDI Loop/Segment

Loop 2300, Segment HI BH

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