Effective May 26, 2009


For all chronic disease and rehabilitation inpatient hospital claims processed on or after May 26, 2009, 
providers will be required to use HIPAA-compliant value code 24 (Medicaid Rate ID) in Field 39 of 
the UB-04.  For direct data entry (DDE) submissions, the Value Code field is found under the Extended 
Services tab.  For EDI submissions, the Value Code is found in the 2300 HI loop, specifically HI01-1(Qualifier) 
and HI01-2 (Value Code).

MassHealth will use specific data submitted on the claim to determine the appropriate inpatient rate at which 
to pay the claim. 

The following chart indicates the data elements that will be used to determine the payment rate.

Provider Type
Type of Bill
Occurrence Code
Rate ID
Description
71
Any type of bill

13
Chronic hospital per diem
71
Any type of bill
21, 22
14
Chronic hospital per diem 
administrative day rate

Note: When billing for administrative days (ADs), providers should enter either 21 (UR Notice 
Received) or 22 (Active Care Ended) in Field 31 of the UB-04, followed by the admission date on the 
claim. For DDE submissions, providers can find the list of occurrences under the Extended Services Tab.  
Providers should click on “New” and enter 22 in the Occurrence Code field of the resulting Occurrence Code 
Detail panel. (See sample Occurrence Code Detail panel below.) Type should be BH- Regular Occurrence 
and the From (Date) should be the admission date. For EDI submissions, the 837I has Occurrence Code in 
the 2300 HI loop.  Providers should enter a qualifier of BH in HI01-1, and either Occurrence Code 21 or 22 
in the HI01-2. Providers should enter a date qualifier in HI01-3 and the date of admission in HI01-4.

 
  
Sample Occurrence Code Detail panel

IMPORTANT VALUE CODE INFORMATION 
for Chronic Disease and Rehabilitation Inpatient Hospitals (Provider Type 71)
 

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