Community First Health Plans (CFHP) requires providers to use correct coding initiatives. In order for claim payment to be received timely, CFHP would like to remind you that the correct discharge status & claim frequency codes are required for accurate claim payment.
A “discharge” occurs when a member leaves an acute care hospital after receiving acute care treatment; or dies in the hospital.
A patient discharge status code is a two-digit code that identifies where the patient is at the conclusion of a healthcare facility encounter or at the end of a billing cycle (the ‘through’ date of a claim).
A claim must include the discharge status code that most accurately reflects the discharge of the patient. The patient discharge status codes listed below is not an all-inclusive list. For these and other discharge codes, and for assistance in the proper reporting of patient discharge status, please refer to the National Uniform Billing Committee (NUBC).
|01||Discharge to Home or Self Care (Routine Discharge)|
|02||Discharged/Transferred to a short term General Hospital for acute care|
|03||Discharged / Transferred to a Skilled Nursing Facility (SNF) with Medicare Certification in Anticipation of Skilled Care|
|04||Discharged/Transferred to facility that provides Custodial or Supportive Care|
|05||Discharged / Transferred to a Designated Cancer Center or Children’s|
|06||Discharged / Transferred to Home Under Care of Organized Home Health Service|
Organization in anticipation of covered skilled care
|07||Left Against Medical Advice or Discontinued Care|
|09||Admitted as an Inpatient to this hospital|
|20||Expired (report only when the patient dies)|
|21||Discharged/ Transferred to Court / Law Enforcement|
|30||Still a Patient|
In addition to the discharge status codes the claim should also include the correct claim frequency code. The claim frequency codes listed below is not an all-inclusive list. For these and other frequency bill codes, and for assistance in the proper claim reporting, please refer to the National Uniform Billing Committee (NUBC).
Type of Bill (fourth Digit) – Frequency of the Bill
|0XX1||Admit through Discharge Claim|
|0XX2||Interim – First Claim|
|0XX3||Interim – Continuing Claim|
|0XX4||Interim – Last claim (Final bill)|
|0XX5||Late Charges Only Claim|
|0XX7||Replacement of Prior Claim|
|0XX8||Void/Cancel of a Prior Claim|
CFHP will edit for correct claim coding. For example, patient discharge status 30 cannot be used when the Type of Bill frequency code is “1” or “5”. CFHP does not allow providers who are contracted using an MS or APR DRG methodology to bill in interim cycles. CFHP requires the entire confinement to be billed in one cycle using the appropriate Type of Bills and Patient Discharge Status codes.
Please contact the Network Management Department at 210-358-6294 if you have any
questions or need assistance.