COT.002.078

OCCURRENCE-CODE-05

Data Element

DE Number

COT078

System DE Number

COT.002.078

File Name

COT - CLAIM OTHER

File Segment Number

COT00002

File Segment Name

CLAIM-HEADER-RECORD-OT

Last updated

02/27/2025

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
Size	X(2)
FLF Start Position	413
FLF Stop Position	414
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be in Occurrence Code List (VVL) 2. Value must be 2 characters 3. Conditional

This data element's valid value code set is maintained by a Code Set Maintenance Organization (CSMO), the official licensing organization for specific valid value code sets. The CSMO is the system of record for those specific valid value code sets. While T-MSIS endeavors to be in-sync with CMSO's updates, minor delays may occur but that shouldn't block T-MSIS data submissions using the CSMO's latest version.

Occurrence Codes

Valid Value Code Set	Valid Value Code	Valid Value Name	Valid Value Description	Effective Start Date	Effective End Date
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RULE ID	RULE Definition
RULE-1437	If the occurrence code 5 is populated on a non-denied claim from an OT file, then the occurrence code 5 reported must be found in the list of valid values for 'occurrence code'.
RULE-6576	If a claim line is a non-denied claim line from an OT file, then the occurrence code 05 value reported must be compatible with specified T-MSIS picture format: X(2).

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Measure ID	Measure Name
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DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP144	CIP.002.144	OCCURRENCE-CODE-05	CIP00002	CLAIM-HEADER-RECORD-IP
CLT096	CLT.002.096	OCCURRENCE-CODE-05	CLT00002	CLAIM-HEADER-RECORD-LT