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March 1, 2007

Reporting Accident Dates to BCBSKS

IF YOU ARE USING OCCURRENCE CODE 11 TO REPORT ACCIDENT DATES, THIS IS INCORRECT AND STARTING IMMEDIATELY THESE CLAIMS WILL BE RETURNED FOR CORRECTION.  PLEASE READ ON.

Providers who bill using the UB-92 billing format use occurrence codes with dates to report accident date information.  The designated accident occurrence codes are:

• 01 – Accident/Medical Coverage – Code indicating accident-related injury for which there is medical payment coverage. 
• 02 – No Fault Insurance Involved – Including Auto Accident/Other – Code indicating the date of an accident including auto or other where state has applicable no fault liability laws (i.e. legal basis for settlement without admission of proof of guilt).
• 03 – Accident/Tort Liability – Code indicating the date of an accident resulting from a third party’s action that may involve a civil court process in an attempt to require payment by the third party, other than no fault liability
• 04 – Accident/Employment Related – Code indicating the date of an accident allegedly relating to the patient’s employment.
• 05 – Accident/No Medical or Liability Coverage – Code indicating accident related injury for which there is no medical payment or third-party liability coverage. 
• 06 – Crime Victim – Code indicating the date on which a medical condition resulted from alleged criminal action committed by one or more parties.

There is also an occurrence code 11 that is used to report the date the patient first became aware of symptoms/illness.  Some providers have interpreted that occurrence code 11 can also be used to report an accident date.  THIS IS INCORRECT.  Occurrence code 11 does not represent accident information.  

Starting immediately, any claim that BCBSKS receives that reflects an accident diagnosis code but does not include one of the designated accident occurrence codes (01, 02, 03, 04, 05, 06) will be returned to the provider for correction. 

NOTE: UB-92 will soon be replaced with UB-04.  These same instructions apply.

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