Intellect™
CLAIM FREQUENCY CODES
Medical billing uses three-digit codes on a claim form to describe the type of bill a provider is submitting to a payor. Each digit has a specific purpose and is required on all UB-04 claims. The 3-digit code includes a two-digit facility type code followed by a one-character claim frequency code. See also UB-04 Facility Type Code in this documentation.
Examples of bill type codes with 'X' representing the frequency code:
11X Hospital Inpatient Part A
12X Hospital Inpatient Part B
Valid Third-Digit Frequency Codes:
|
0 |
Non-payment/Zero Claim |
|
1 |
Admit Through Discharge |
|
2 |
Interim – First Claim |
|
3 |
Interim – Continuing Claims (Not valid for PPS Bills) |
|
4 |
Interim – Last Claim (Not valid for PPS Bills) |
|
5 |
Late Charges Only (Outpatient claims only) |
|
7 |
Replacement of Prior Claim |
|
8 |
Void/Cancel of Prior Claim |
|
9 |
Final claim for Home Health PPS Episode |
|
A |
Admission/Election Notice for Hospice |
|
B
|
Hospice/Medicare Coordinated Care Demonstration/Religious Nonmedical Health Care Institution Termination/Revocation Notice |
|
C |
Hospice Change of Provider Notice |
|
D |
Hospice/Medicare Coordinated Care Demonstration/Religious Nonmedical Health Care Institution Void/Cancel |
|
E |
Hospice Change of Ownership |
|
|
|
|
** |
The following are for Fiscal Intermediary use only ** |
|
F |
Beneficiary Initiated |
|
G |
CWF Initiated Adjustment Claim |
|
H |
CMS Initiated Adjustment Claim |
|
I |
FI/MAC Adjustment Claim (Other than QIO or Provider) |
|
J |
Initiated Adjustment Claim – Other |
|
K |
OIG Initiated Adjustment Claim |
|
M |
MSP Initiated Adjustment Claim |
|
P |
QIO Initiated Adjustment Claim |
Please check the current manual for any changes or revisions:
CMS: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c25.pdf (revised 1/11/2019)
Noridian: https://med.noridianmedicare.com/web/jea/topics/claim-submission/bill-types (updated August 30, 2018)