Claim Occurrence Span Table


Property

Specification

Data System

NCH Nearline File: Version I

Record Type

Code Table

Comments

70 = Eff 10/93, payer use only, the
nonutilization 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 noncovered
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 noncovered 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 noncovered period
77 = Provider liability - The from/thru
dates of period of noncovered care
for which the provider is liable.
Eff 3/92, 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 = (Payer code) -
Eff 3/92, from/thru dates of
period of noncovered care where
bene is not charged with utilization,
deductible, or coinsurance.
and provider is liable.
Eff 9/93, noncovered period of care
due to lack of medical necessity.
80 - 99 = Reserved for state assignment
M0 = PRO/UR approved stay dates - Eff 10/93,
the first and last days that were
approved where not all of the stay was
approved.



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Generated: 01/13/2003 09:45:09 PM