Per-diem & institutional billing

Outcome

A multi-day institutional stay — ICF, ICF-IID, residential, hospital — is recorded with admission, discharge, leaves of absence, and any required occurrence / value codes, then billed as a UB-04 / 837I per the program's billing period (daily / weekly / monthly / span).

Prerequisites

Scope	What it lets you do
clinical.encounter.read	View encounters and stays
clinical.encounter.write	Edit institutional context
billing.claim.write	Build / submit institutional claims

A program configured with institutionalBillingPeriod (see 5.1 — Payers, programs & contracts). The setting drives how the platform groups per-diem charges into a claim.

Where to find institutional context

The Claim detail page has an Institutional tab visible only when the underlying claim's filing type is INSTITUTIONAL. The page also exposes a Per-diem panel in the sidebar that shows the LOS calculation.

Institutional context fields

Field	Where it travels
Admit date / time	DTP*435 ADM
Admit type	Header — emergency / urgent / elective.
Admit source	Header.
DRG	HI*DR segment in the 2300 loop.
Discharge date / hour / status	DTP*096 DIS and CL103.
Length of stay (LOS)	Computed; not transmitted explicitly but drives covered-day count.
Leave of absence (LOA) dates	OCC-74 occurrence code + dates.
Covered / non-covered days	VAL-80 / VAL-81 value amounts.
Diagnosis pointers	HI*BK (principal), HI*BF (additional).
Procedure codes (ICD-10-PCS)	HI*BBR (principal), HI*BBQ (other).

The platform auto-emits these segments when the corresponding context fields are set on the claim. Setting only some fields is allowed — the platform skips segments whose fields are blank.

Steps to record a stay

1. Open the member at /members/:id. Click + New stay (under the Encounters tab).

2. Fill the admission: facility, admit date / time, admit type, admit source, principal diagnosis. Save.

3. As the stay progresses, leaves of absence get recorded:

   • From the stay's Stay detail page, click + Add LOA with the start / end date and the reason.
   • The platform automatically creates the OCC-74 row that will travel on the eventual claim.

4. At discharge, click Discharge and fill discharge date, hour, status. The stay closes and the per-diem charges become eligible for claim build.

Steps to bill the stay

1. Open the stay → click Build claim (or visit /charges/bulk-entry where the per-diem charges show up grouped under the stay).

2. Pick the billing period if the program supports more than one. Common choices:

   Period	What goes on the claim
   DAILY	One claim per day.
   WEEKLY	All days in a 7-day window.
   MONTHLY	All days in a calendar month.
   SPAN	Admission through discharge as a single claim.

   The default comes from institutionalBillingPeriod on the program config; override per-claim if needed.

3. Confirm institutional context. The Institutional tab shows what the platform will emit. Edit any field that is wrong; the platform validates:

   • DRG must be a valid code from the master DRG table.
   • LOA dates must fall within admit / discharge.
   • Covered + non-covered days must equal LOS.

4. Build / submit as in 2.1 — Build & submit a claim.

Validation

Check	Expected
Stay closes cleanly on discharge	Yes; admit/discharge dates rendered as ISO.
LOA rows produce OCC-74 segments	Yes; visible on the Submission tab's EDI download.
Covered + non-covered days sum to LOS	Yes; validation blocks save if not.
837I includes HI*DR when DRG is set	Yes.
Per-diem grouping matches institutionalBillingPeriod	Yes.

Troubleshooting

Symptom	Cause	Fix
Claim built as 837P instead of 837I	Filing type on the program is PROFESSIONAL	Edit the program config (5.1) to INSTITUTIONAL.
Save returns "DRG not in master table"	Typo or out-of-date master	Correct the DRG; or have a tenant admin refresh the DRG master.
Per-diem charges missing for some covered days	LOA was recorded for those days	Review LOA windows; if recorded incorrectly, edit and rebuild.
Claim rejected: "occurrence code 74 has no associated date"	LOA without a paired date	Edit the LOA; ensure both start and end are filled.

Next

4.1 — Visits & compliance overview