Variable: CLM_RLT_OCRNC_CD
Claim Related Occurrence Code
Description
The code that identifies a significant event relating to an institutional claim that may affect payer processing. These codes are associated with a specific date (the claim related occurrence date).
Comment
n/a
Values
This variable is coded, and will contain one of the following values.
| Value | Description |
|---|---|
| 01 | Auto accident - The date of an auto accident. |
| 02 | No-fault insurance involved, including auto accident/other - The date of an accident where the state has applicable no-fault liability laws, (i.e., legal basis for settlement without admission or proof of guilt). |
| 03 | Accident/tort liability - The date of an accident resulting from a third party's action that may involve a civil court process in an attempt to require payment by the third party, other than no-fault liability. |
| 04 | Accident/employment related - The date of an accident relating to the patient's employment. |
| 05 | Other accident - The date of an accident not described by the codes 01 thru 04. |
| 06 | Crime victim - Code indicating the date on which a medical condition resulted from alleged criminal action committed by one or more parties. |
| 07 | Reserved for national assignment. |
| 08 | Reserved for national assignment. |
| 11 | Onset of symptoms/illness - The date the patient first became aware of symptoms/illness. |
| 12 | Date of onset for a chronically dependent individual - Code indicates the date the patient/bene became a chronically dependent individual. |
| 13 | Reserved for national assignment. |
| 14 | Reserved for national assignment. |
| 15 | Reserved for national assignment. |
| 16 | Reserved for national assignment. |
| 17 | Date outpatient occupational therapy plan established or last reviewed - Code indicating the date an occupational therapy plan was established or last reviewed. |
| 18 | Date of retirement (patient/bene) - Code indicates the date of retirement for the patient/bene. |
| 19 | Date of retirement spouse - Code indicates the date of retirement for the patient's spouse. |
| 20 | Guarantee of payment began - The date on which the provider began claiming Medicare payment under the guarantee of payment provision. |
| 21 | UR notice received - Code indicating the date of receipt by the hospital & SNF of the UR committee's finding that the admission or future stay was not medically necessary. |
| 22 | Active care ended - The date on which a covered level of care ended in a SNF or general hospital, or date active care ended in a psychiatric or tuberculosis hospital or date on which patient was released on a trial basis from a residential facility. Code is not required if code "21" is used. |
| 23 | Cancellation of Hospice benefits - The date the RHHI cancelled the hospice benefit. (eff. 10/00). NOTE: this will be different than the revocation of the hospice benefit by beneficiaries. |
| 24 | Date insurance denied - The date the insurer's denial of coverage was received by a higher priority payer. |
| 25 | Date benefits terminated by primary payer - The date on which coverage (including worker's compensation benefits or no-fault coverage) is no longer available to the patient. |
| 26 | Date skilled nursing facility (SNF) bed available - The date on which a SNF bed became available to a hospital inpatient who required only SNF level of care. |
| 27 | Date of Hospice Certification or Re-Certification -- code indicates the date of certification or recertification of the hospice benefit period, beginning with the first two initial benefit periods of 90 days each and the subsequent 60-day benefit periods. (eff. 9/01) |
| 27 | Date home health plan established or last reviewed - Code indicating the date a home health plan of treatment was established or last reviewed. (Obsolete) not used by hospital unless owner of facility |
| 28 | Date comprehensive outpatient rehabilitation plan established or last reviewed - Code indicating the date a comprehensive outpatient rehabilitation plan was established or last reviewed. Not used by hospital unless owner of facility |
| 29 | Date OPT plan established or last reviewed - the date a plan of treatment was established for outpatient physical therapy. Not used by hospital unless owner of facility |
| 30 | Date speech pathology plan treatment established or last reviewed - The date a speech pathology plan of treatment was established or last reviewed. Not used by hospital unless owner of facility |
| 31 | Date bene notified of intent to bill (accommodations) - The date of the notice provided to the patient by the hospital stating that he no longer required a covered level of IP care. |
| 32 | Date bene notified of intent to bill (procedures or treatment) - The date of the notice provided to the patient by the hospital stating requested care (diagnostic procedures or treatments) is not considered reasonable or necessary. |
| 33 | First day of the Medicare coordination period for ESRD bene - During which Medicare benefits are secondary to benefits payable under an EGHP. Required only for ESRD beneficiaries. |
| 34 | Date of election of extended care facilities - The date the guest elected to receive extended care services (used by Religious Nonmedical Health Care Institutions only). |
| 35 | Date treatment started for physical therapy - Code indicates the date services were initiated by the billing provider for physical therapy. |
| 36 | Date of discharge for the IP hospital stay when patient received a transplant procedure - Hospital is billing for immunosuppressive drugs. |
| 37 | The date of discharge for the IP hospital stay when patient received a non-covered transplant procedure - Hospital is billing for immunosuppressive drugs. |
| 38 | Date treatment started for home IV therapy - Date the patient was first treated in his home for IV therapy. |
| 39 | Date discharged on a continuous course of IV therapy - Date the patient was discharged from the hospital on a continuous course of IV therapy. |
| 40 | Scheduled date of admission - The date on which a patient will be admitted as an inpatient to the hospital. (This code may only be used on an outpatient claim.) |
| 41 | Date of First Test for Pre-admission Testing - The date on which the first outpatient diagnostic test was performed as part of a pre-admission testing (PAT) program. This code may only be used if a date of admission was scheduled prior to the administration of the test(s). (eff. 10/01) |
| 42 | Date of discharge/termination of hospice care - for the final bill for hospice care. Date patient revoked hospice election. |
| 43 | Scheduled Date of Canceled Surgery - date which ambulatory surgery was scheduled. (eff. 9/01) |
| 44 | Date treatment started for occupational therapy - Code indicates the date services were initiated by the billing provider for occupational therapy. |
| 45 | Date treatment started for speech therapy - Code indicates the date services were initiated by the billing provider for speech therapy. |
| 46 | Date treatment started for cardiac rehabilitation - Code indicates the date services were initiated by the billing provider for cardiac rehabilitation. |
| 47 | Date Cost Outlier Status Begins - code indicates that this is the first day the cost outlier threshold is reached. For Medicare purposes, a bene must have regular coinsurance and/or lifetime reserve days available beginning on this date to allow coverage of additional daily charges for the purpose of making cost outlier payments. (eff. 9/01) |
| 48 | Payer code - Code reserved for internal use only by third party payers. CMS assigns as needed for your use. Providers will not report it. |
| 49 | Payer code - Code reserved for internal use only by third party payers. CMS assigns as needed for your use. Providers will not report it. |
| 50-69 | Reserved for state assignment |
| A1 | Birthdate, Insured A - The birthdate of the individual in whose name the insurance is carried. |
| A2 | Effective date, Insured A policy - A code indicating the first date insurance is in force. |
| A3 | Benefits exhausted - Code indicating the last date for which benefits are available and after which no payment can be made to payer A. |
| B1 | Birthdate, Insured B - The birthdate of the individual in whose name the insurance is carried. |
| B2 | Effective date, Insured B policy - A code indicating the first date insurance is in force. |
| B3 | Benefits exhausted - code indicating the last date for which benefits are available and after which no payment can be made to payer B. |
| C1 | Birthdate, Insured C - The birthdate of the individual in whose name the insurance is carried. |
| C2 | Effective date, Insured C policy - A code indicating the first date insurance is in force. |
| C3 | Benefits exhausted - Code indicating the last date for which benefits are available and after which no payment can be made to payer C. |
Other Info
Some additional information on this variable:
- Short Name: OCRNC_CD
- Long Name: CLM_RLT_OCRNC_CD
- Type: CHAR
- Length: 2
- Source: NCH
- Value Format: