Variable: CLM_SPAN_CD
Claim Occurrence Span Code
Description
The code that identifies a significant event relating to an institutional claim that may affect payer processing. These codes are claim-related occurrences that are related to a time period span of dates (variables called the CLM_SPAN_FROM_DT and CLM_SPAN_THRU_DT).
Comment
n/a
Values
This variable is coded, and will contain one of the following values.
| Value | Description |
|---|---|
| 70 | Payer use only, the non-utilization from/thru dates for PPS-inlier stay where bene had exhausted all full/coinsurance days, but covered on cost report. SNF qualifying hospital stay from/thru dates |
| 71 | Hospital prior stay dates – the from/thru dates of any hospital stay that ended within 60 days of this hospital or SNF admission. |
| 72 | First/last visit – the dates of the first and last visits occurring in this billing period if the dates are different from those in the statement covers period. |
| 73 | Benefit eligibility period – the inclusive dates during which CHAMPUS medical benefits are available to a sponsor's bene as shown on the bene's ID card. |
| 74 | Non-covered level of care – The from/thru dates of a period at a non-covered level of care in an otherwise covered stay, excluding any period reported with occurrence span code 76, 77, or 79. |
| 75 | The from/thru dates of SNF level of care during IP hospital stay. Shows PRO approval of patient remaining in hospital because SNF bed not available. Not applicable to swing bed cases. PPS hospitals use in day outlier cases only. |
| 76 | Patient liability – From/thru dates of period of non-covered care for which hospital may charge bene. The FI or PRO must have approved such charges in advance. Patient must be notified in writing 3 days prior to non-covered period |
| 77 | Provider liability (utilization charged) – The from/thru dates of period of non-covered care for which the provider is liable. Applies to provider liability where bene is charged with utilization and is liable for deductible/coinsurance |
| 78 | SNF prior stay dates – The from/thru dates of any SNF stay that ended within 60 days of this hospital or SNF admission. |
| 79 | Provider Liability (non-utilization) (Payer code) – from/thru dates of period of non-covered care where bene is not charged with utilization, deductible, or coinsurance; and provider is liable. Non-covered period of care due to lack of medical necessity. |
| 80-99 | Reserved for state assignment |
| M0 | PRO/UR approved stay dates – the first and last days that were approved where not all of the stay was approved. |
| M1 | Provider Liability-No Utilization – from/thru dates of a period of non-covered care that is denied due to lack of medical necessity or custodial care for which the provider is liable. (eff. 10/01) |
| M2 | Dates of Inpatient Respite Care – from/thru dates of a period of inpatient respite care for hospice patients. (eff. 10/00) |
Other Info
Some additional information on this variable:
- Short Name: SPAN_CD
- Long Name: CLM_SPAN_CD
- Type: CHAR
- Length: 2
- Source: NCH
- Value Format: