FLs 31-34 on the UB-04 are used for reporting occurrence codes—two-digit numeric or alphanumeric codes that identify significant events connected with a claim that affect its processing and payment. Payers use occurrence code information and corresponding dates to determine liability issues, coordinate benefits, clarify patient eligibility, and make final decisions about the benefits due on a claim.
Occurrence codes are generally grouped into four categories for ease of reference: accident-related codes, medical condition codes, insurance-related codes, and service-related codes.
FLs 35-36 on the UB-04 are used to record occurrence span codes and dates. Like occurrence codes, occurrence span codes identify significant events—that occur over a period of time—that influence the payment process. For example, occurrence span code 76 (Patient liability) and its corresponding dates indicate the period of noncovered care for which the hospital is permitted to charge the Medicare beneficiary.
Various billing situations arise when particular occurrence codes and occurrence span codes are used. For example, the accident-related occurrence codes (01-06) indicate that Medicare is not the primary payer for the claim and that MSP provisions apply. If code 24 (Date insurance denied) is used to bill Medicare for a conditional payment, the claim must contain an explanation of the request for the conditional payment in the Remarks field (FL 80); without such an explanation, the payer will not be able to process the claim properly. When occurrence span code 74 (Noncovered level of care/leave of absence dates) is used, it excludes any period reported with the usual occurrence span codes
that are used to report noncovered care (codes 76 and 77).
Most occurrence codes and occurrence span codes contain data that must be coordinated with data in several other fields on the UB-04. For example, when an accident code is used, the accident hour as well as the appropriate value code and amount paid by the primary payer must also be reported in FLs 39-41 (Value Codes and Amounts). Similarly, when occurrence span code 76 (Patient liability) is used to report a span of noncovered care for which the patient is responsible, FLs 39-41 should report the appropriate value code and amount the patient is responsible for, as well as the appropriate value code to report the total number of noncovered days and either occurrence code 31 (Date beneficiary notified of intent to bill—accommodations) or 32 (Date beneficiary notified of intent to bill—procedures or treatment).
FL 37 on the UB-04 is an unlabeled field that is reserved for national assignment. FL 38, Responsible Party Name and Address, is used mostly by commercial carriers. The name and address of the party responsible for the bill are recorded in this form locator and can show through when the bill is mailed in a window envelope. Although not required for Medicare claims, FL 38 may be used to report the name and address of a payer that is primary to Medicare when Medicare is not the primary payer on the claim.
