<< Previous Data Element X12-837 Input Table of Contents Next Data Element >>
Data Element Name:  Occurrence Span Information - ALC and LOA Dates
Format-Length:  A/N - 2 Required For:  IP
Effective Date:  1/1/94 Revision Date:  September 2003

NOTE: This is a composite data element. Up to 30 Occurrence Span Codes can be reported. For mapping guidelines refer to the Inpatient 837 Addendum.
National Standard Mapping:

Electronic - 837I
X12 Loop
Ref. Des.
Data Element
Code
Description
Version 4050R 2300 HI01-1 1270 BI Occurrence Span Qualifier
HI01-2 1271 Occurrence Span Code
HI01-3 1250 RD8 Date Qualifier (CCYYMMDD)
HI01-4 1251 Date Value
Paper Form Locator Code Qualifier
Institutional - UB-04 35-36 N/A

Definition:

  1. The code which identifies the specific Type of Alternate Level of Care required for a patient determined to need a level of care other than acute during their hospitalization and the corresponding from and through span dates; OR

  2. The span dates that identify when a patient was in Leave of Absence status.

Codes and Values:

  1. 74 = Leave of Absence

    75 = SNF Level of Care or Residential Health Care Facility

    81 = Home Health Services

    82 = Other Institution

  2. Enter the associated Dates in a corresponding Occurrence Span Code From and Through Date Fields in CCYYMMDD format.

  3. The Dates must be valid in accordance with the Date Edit Validation Table in Appendix A.

Example:  HI*BI:74:RD8:20060413-20060414~

Edit Applications:

  1. If an Occurrence Span Code is reported, then a valid Occurrence Span Code From and Through Date must also be reported.

  2. The Occurrence Span Code From Date must be on or before the Occurrence Span Code Through Date for each Occurrence Span Code that is reported.

  3. The Occurrence Span Code From and Through dates must be within the stay as defined by the Admission Date/Start of Care and the Statement Covers Period - Thru Date.

  4. SPARCS allows a maximum of 30 Occurrence Spans.
<< Previous Data Element X12-837 Input Table of Contents Next Data Element >>