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FISS/DDE Provider Online Guide: Chapter IV


OSC Repository Inquiry (1A)

Purpose

An occurrence span code identifies a specific event that relates to the payment of the claim that spans several days. The dates identify the commencement and ending of the event. Up to ten occurrence span codes may be reported on each claim.

The purpose of the OSC REPOSITORY INQUIRY screen is to display the claim’s occurrence span code repository record.

FISS Inquiry Submenu

To access the OSC REPOSITORY INQUIRY option from the FISS online INQUIRIES submenu, type ‘1A’ at the Enter Menu Selection: prompt and press the <Enter> key.

Upon selecting the OSC REPOSITORY INQUIRY option, the DDE OSC REPOSITORY INQUIRY screen is available:

DDE OSC Repository Inquiry screen

Field Description
Provider
Provider number ‑ identification number of the provider who is signed on
HIC Medicare beneficiary number (12-position alphanumeric field)
ADMIT DATE Patient’s Admission Date (a six-digit field in MMDDYY format)
DOCUMENT CONTROL NUMBER Document Control Number ‑ identifies the DCN for a claim (23-position alphanumeric field)
OSC Occurrence Span Code ‑ identifies events that relate to the payment of the claim. This is a two-position alphanumeric field.
FROM DATE The occurrence span “from” date identifies the commencement date of the event that relates to the payment of a claim (eight-digit formatted date field in MMDDCCYY format)
TO DATE The occurrence span “to” date identifies the ending date of the event that relates to the payment of a claim (eight-digit formatted date field in MMDDCCYY format)

To access the OSC details from a specific claim, enter the beneficiary Medicare number in the HIC field and the date of admission in the ADMIT DATE field, then press the <Enter> key.

Occurrence Span Codes

Code Title Description
M0 QIO/UR Stay Dates Partial approval – claim reviewed by PRO; some portion denied. Identifies the approved billing period
M1 Provider Liability - No Utilization Identifies a period of noncovered care that is denied due to lack of medical necessity or as custodial care for which the provider is liable. The beneficiary is not charged with utilization. The provider may not collect Part A or Part B deductible or coinsurance from the beneficiary.
M2 Dates of Inpatient Respite Care Identifies a period of inpatient respite care for hospice patients.
M3 ICF Level of Care Identifies a period of intermediate level of care during an inpatient hospital stay.
M4 Residential Level of Care Identifies a period of residential level of care during an inpatient stay.
M5‑MQ - Reserved for assignment by the NUBC
MR - Reserved for disaster related occurrence span code
MS - Reserved for assignment by the NUBC
70 Qualifying Stay Dates Identifies a hospital stay of at least three days which qualifies the patient for payment of the SNF level of care services billed on this claim. (Part A claims for SNF level of care only.)
70 Nonutilization Dates (for payer use on hospital bills only) A period of time during a PPS inlier stay for which the beneficiary had exhausted all regular days and/or coinsurance days, but which is covered on the cost report.
71 Prior Stay Dates Identifies dates given by the patient for any hospital stay that ended within 60 days of this hospital or SNF admission. (Part A claims only.)
72 First/Last Visit Identifies the first and last visits occurring in this billing period where these dates are different from the Statement Covers Period.
74 Noncovered Level of Care Identifies repetitive Part B services to show a period of inpatient hospital care or of outpatient surgery during the billing period.
75 SNF Level of Care Identifies a period of SNF level of care during an inpatient hospital stay. Since PRO’s no longer routinely review inpatient hospital bills for hospitals under PPS, this code is needed only in length of stay outlier cases. It is not applicable to swing-bed hospitals which transfer patients from the hospital to a SNF level of care.
76 Patient Liability Identifies a period of noncovered care for which the hospital is permitted to charge the beneficiary. Code is to be used only where you or the PRO approve such charges in advance and the patient is notified in writing three days prior to the “From” date of this period.
77 Provider Liability – utilization charged Identifies a period of noncovered care for which the provider is liable (other than for lack of medical necessity or as custodial care.) The beneficiary’s record is charged with Part A days, Part A or Part B deductible, and Part B coinsurance. The provider may collect Part A or Part B deductible and coinsurance from the beneficiary.
78 SNF Prior Stay Dates Identifies a SNF stay that ended within 60 days of this hospital or SNF admission. An inpatient stay in a facility or part of a facility that is certified or licensed by the State solely below a SNF level of care does not continue a spell of illness. (Part A claims only.)
79 Verified Noncovered Stay Dates for Which the Provider is Liable Verified noncovered stay dates for which the provider is liable
80 Prior same SNF Stay Dates for Payment Ban Purposes Identifies a prior same-SNF stay indicating a patient resided in the SNF prior to, and if applicable, during a payment ban period up until their discharge to a hospital.

[Return to FISS/DDE Provider Online Guide Index]

FISS/DDE Provider Online Guide: Chapter IV - OSC Repository Inquiry (1A)
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