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June 14, 2013

837I Editing for Occurrence Code 55

Beginning 8/18/2013, a new edit enforcing NUBC billing guidelines will be implemented for   the following payers:

  • BCBSKC (47171)
  • BCBSKS (41763)
  • HealthNow New York, BCBSWNY, BSNENY (55204, 00800, 00301, 00801)

Purpose:  If an institutional claim indicates a patient discharge status of 20, 40, 41 or 42 (patient expired), then Occurrence Code 55 (date of death) must be reported.

Edit Logic:  Occurrence Code 55 (date of death) (2300 HI01-1 through HI12-2 when HI01-1=BH) is required when the patient discharge status (2300 CL103) = 20, 40, 41 or 42, else reject

Edit Code:  A8:234 / A8:719

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