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2012 Texas Medicaid Provider Procedures Manual

Volume 1, General Information : Section 6: Claims Filing : 6.6 UB-04 CMS-1450 Paper Claim Filing Instructions : 6.6.5 Occurrence Codes

6.6.5
 
Auto accident/auto liability insurance involved
Enter the date of an auto accident. Use this code to report an auto accident that involves auto liability insurance requiring proof of fault.
Auto or other accident/
no fault involved
Enter the date of the accident including auto or other where no-fault coverage allows insurance immediate claim settlement without proof of fault. Use this code in conjunction with occurrence codes 24, 50, or 51 to document coordination of benefits with the no-fault insurer.
Enter the date of an accident (excluding automobile) resulting from a third party’s action. This incident may involve a civil court action in an attempt to require payment by the third party other than no‑fault liability.
Refer to:
Subsection 4.13.6, “Third Party Liability - Tort” in Section 4, “Client Eligibility” (Vol. 1, General Information).
Accident/ employment-related
Enter the date of an accident that allegedly relates to the patient’s employment and involves compensation or employer liability.
Use this code in conjunction with occurrence codes 24, 50, or 51 to document coordination of benefits with Workers’ Compensation insurance or an employer. Only services not covered by Workers’ Compensation may be considered for payment by Medicaid.
Date outpatient OT plan established or last reviewed
Date benefits terminated by primary payer
Date home health plan of treatment was established
Date outpatient PT plan established or last reviewed
Date outpatient speech pathology plan established or last reviewed
Date treatment started for speech-language pathology (SLP)
Date claim filed with other insurance

Texas Medicaid & Healthcare Partnership
CPT only copyright 2011 American Medical Association. All rights reserved.