About bill types

What is a Bill Type, and why is it important?

The Bill Type, or Type of Bill (TOB), is a three-digit numeric code on the claim that identifies the specific type of bill being sent to the payer. The first digit represents Type of Facility (Hospital, Skilled Nursing, etc.), the second digit represents the Bill Classification (Inpatient, Outpatient, etc.), and the third digit represents the Frequency (Admit/Discharge, Late Charges, Series, etc.).

The TOB submitted on the claim is important not only for filtering which provision the claim will calculate on, but also for how the claim is handled during import. For every patient account, the importing logic first checks whether the account already exists in the system. If it does, the system applies a series of logical statements and the instance of the claim is brought in as Active, an Exception, or a Voided Record. All claims are brought in as the Active claim if no other instance of the claim exists, and as long as the claim is not a Late Charge (i.e., TOB XX5) or a Voided Record (i.e., TOB XX8).

A Late Charge is always brought into the system as an Exception Record. If an active record exists for that patient account, the late charge is attached to the active claim and the line items from the late charge are appended to the active record. If no active record exists, the late charge claim sits idle as an Exception until an active record is brought in for that particular account number. At that time, it appends to the newly imported active claim.

Series TOBs (i.e., XX2, XX3 and XX4) are handled differently. If a Series Start bill (i.e., XX2) already exists in the system and another is imported, the imported one becomes the new Active claim and the previous instance is considered Replaced. The same applies to a Series End TOB (i.e., XX4). Multiple Series Interim bills can exist on a claim; however, if an XX3 comes in and has the same admit and discharge dates as a previous XX3, as well as the same total charges, it will replace the matching instance.

The standard Admit/Discharge claim (i.e., XX1) always comes in as active, and replaces the existing active record as long as the charges are equal to or greater than the current record. The claim comes in as an Exception if total charges are less than the existing claim. A Replacement claim (i.e., XX7) always replaces the existing active record no matter what the total charges are for the claim, and regardless of whether or not there are late charges appended to the current record.

Replacement and Late Charge claims are not allowed with Series claims. Both come in as Exception records if a series TOB exists on the account. The reverse is true as well. Series claims are not allowed on non-series accounts.