Claim Frequency Code (Encounter)

SAS Name

The third digit of the type of bill (TOB3) submitted on an institutional claim record to indicate the sequence of a claim in the beneficiary's current episode of care. 


This code is used for encounter final action processing for all encounter claim types, including carrier.

The encounter bill type frequency codes utilize a similar nomenclature to Medicare fee for service bill type frequency codes. This field can be used in determining the "type of bill" for an institutional claim. Often the type of bill consists of a combination of two variables: the facility type code (variable called CLM_FAC_TYPE_CD) and the service classification type code (CLM_SRVC_CLSFCTN_TYPE_CD).

This variable serves as the optional third component of bill type. Many different types of services can be appear on an encounter institutional claim, and knowing the type of bill helps to distinguish them. The type of bill is the concatenation of three variables: the facility type (CLM_FAC_TYPE_CD), the service classification type code (CLM_SRVC_CLSFCTN_TYPE_CD), and the claim frequency code (CLM_FREQ_CD).

A 3-part type of bill is the concatenation of three variables:

  • facility type (CLM_FAC_TYPE_CD)
  • service classification type (CLM_SRVC_CLSFCTN_TYPE_CD)
  • claim frequency code (CLM_FREQ_CD)

Source: Medicare Advantage Organizations (MAOs) 

Code Code value
0 Non-payment/zero claims
1 Admit thru discharge claim
2 Interim – first claim
3 Interim – continuing claim
4 Interim – last claim
5 Late charge(s) only claim
7 Replacement of prior claim
8 Void/cancel prior claim
9 Final claim (for HH PPS = process as a debit/credit to RAP claim)
A Admission election notice (when hospice or Religious Nonmedical Health Care Institution is submitting the HCFA-1450 as an admission notice; this is to establish a hospice benefit period)
G Common Working File (NCH) generated adjustment claim
H CMS generated adjustment claim
I Misc. adjustment claim (e.g., initiated by intermediary or QIO)
P Adjustment required by QIO