Claim Frequency 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. Often type of bill consists of a combination of two variables: the facility type code (variable called CLM_FAC_TYPE_CD) and the service classification type code (CLM_SRVC_CLSFCTN_TYPE_CD). This variable serves as the optional third component of bill type, and it is helpful for distinguishing between final, interim, or RAP (request for anticipated payment) claims - which is particularly helpful if you receive claims that are not "final action".
Many different types of services can be billed on a Part A or Part B institutional claim, and knowing the type of bill helps to distinguish them. The type of bill is the concatenation of three variables : the facility type (CLM_FAC_TYPE_CD), the service classification type code (CLM_SRVC_CLSFCTN_TYPE_CD), and the claim frequency code (CLM_FREQ_CD).
This variable is coded, and will contain one of the following values.
| Value | Description |
|---|---|
0 |
Non-payment/zero claims |
1 |
Admit thru discharge claim |
2 |
Interim – first claim |
3 |
Interim – continuing claim |
4 |
Interim – last claim |
5 |
Late charge(s) only claim |
7 |
Replacement of prior claim |
8 |
Void/cancel prior claim |
9 |
Final claim (for HH PPS = process as a debit/credit to RAP claim) |
G |
Common Working File (NCH) generated adjustment claim |
H |
CMS generated adjustment claim |
I |
Misc. adjustment claim (e.g., initiated by intermediary or QIO) |
J |
Other adjustment request |
M |
Medicare secondary payer (MSP) adjustment |
P |
Adjustment required by QIO |
Some additional information on this variable: