Claim Frequency Code (FFS)

SAS Name
CLM_FREQ_CD

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.

Comments

This field can be used in determining the “type of bill” for an institutional claim. Often 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, and it is helpful for distinguishing between final, interim, or RAP (request for anticipated payment) claims — which is particularly helpful if you receive claims that are not “final action.”

Many different types of services can be billed on a Part A or Part B 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).

Source: NCH

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)
G Common Working File (NCH) generated adjustment claim
H CMS generated adjustment claim
I Misc adjustment claim (e.g., initiated by intermediary or QIO)
J Other adjustment request
K OIG Initiated Adjustment Claim
M Medicare secondary payer (MSP) adjustment
P Adjustment required by QIO
Q Reopening/Adjustment requested by provider. Used when the submission falls outside of period to submit an adjustment bill