Box 31-34 Occurrence Code/Date

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.
2. Click on the Intake quick link for the treatment episode.
3. On the Admit/Discharge tab, click Edit.
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