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.
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.
- Navigate to Patients and click on the Patient Name.
- Click on the Intake quick link for the treatment episode.
- On the Admit/Discharge tab, click Edit.
- Add or update the Occurrence Code and Occurrence Code Date fields.
- Click Save.
- Next, set up a claim rule for the desired payer. Click here for instructions.
- 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.
- 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.
|No Fault Insurance Involved - Including Auto Accident/Other
|Accident/ Employment Related
|Accident/No Medical or Liability Coverage
|Start of Infertility Treatment Cycle
|Last Menstrual Period
|Onset of Symptoms/Illness
|Date of Onset for A Chronically Dependent Individual
|Date of Last Therapy
|Date Outpatient Occupational Therapy Plan Established or Last Reviewed
|Date of Retirement - Patient/Beneficiary
|Date of Retirement - Spouse
|Date Guarantee of Payment Began
|Date Ur Notice Received
|Date Active Care Ended
|Date Insurance Denied
|Date Benefits Terminated by Primary Payer
|Date SNF Bed Became Available
|Date of Hospice Certification or Recertification
|Date Comprehensive Outpatient Rehabilitation Plan Established or Last Reviewed
|Date Outpatient Physical Therapy Plan Established or Last Reviewed
|Date Outpatient Speech Pathology Plan Established or Last Reviewed
|Date Beneficiary Notified of Intent to Bill (Accommodations)
|Date Beneficiary Notified of Intent to Bill (Procedures or Treatments)
|First Day of The Coordination Period for ESRD Beneficiaries Covered By EGHP
|Date of Election of Extended Care Facilities
|Date Treatment Started for Physical Therapy
|Date of Inpatient Hospital Discharge for Covered Transplant Patient
|Date of Inpatient Hospital Discharge for Non-Covered Transplant Patient
|Date Treatment Started for Home IV Therapy
|Date Discharged on a Continuous Course of IV Therapy
|Scheduled Date of Admission
|Date of First Test for Pre-Admission Testing
|Date of Discharge
|Scheduled Date of Canceled Surgery
|Date Treatment Started for Occupational Therapy
|Date Treatment Started for Speech Therapy
|Date Treatment Started for Cardiac Rehabilitation
|Date Cost Outlier Status Begins
|Assessment Date (Effective 1/1/11)
|Date of Last Kt/V Reading (Effective 7/1/10)
|Medical Certification/Recertification Date (Effective 1/1/11)
|Physician Follow-Up Date (Effective 1/1/11)
|Date of Death (Effective 10/1/12)
|Original Hospice Election or Revocation Date (Effective 1/1/18)
|Hospital Discharge Date (HHA Only) (Effective 1/1/20)
|Other Institutional Discharge Date (HHA Only) (Effective 1/1/20)
|Birthdate - Insured A
|Effective Date - Insured A Policy
|Benefits Exhausted - Payer A
|Split Bill Date
|Birthdate - Insured B
|Effective Date - Insured B Policy
|Benefits Exhausted - Payer B
|Birthdate - Insured C
|Effective Date - Insured C Policy
|Benefits Exhausted - Payer C
|Reserved for Disaster Related Occurrence Code
Loop 2300, Segment HI BH