12811

FISS Narrative:
Occurrence code must be blank or be a two character code of 01 through 99, A0 through Z9 or AA-ZZ with a valid date.

Explanation and Suggestion:

  • For occurrence codes 21, the associated date cannot be after the claim "Thru" date
  • For occurrence code 22, the associated date must be within the "From" and "Thru" date of the claim, unless the claim has a non-payment code of C, N or W then the date can be prior to the "From" date
  • For occurrence codes 26, 32 or 42 the associated date must be within the "From" and "Thru" date of the claim
  • Note: The 4th digit of the reason code indicates the position in which the error occurred. The sequence is 1-0 (0 denotes the 10th occurrence) and A-T (T denotes the 30th occurrence).

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