Inpatient Claims Exceeding $10 Million – Billing Requirements

Jun 11, 2026 | Provider Resource

Community First Health Plans (Community First) is providing guidance on the proper billing of inpatient claims totaling $10 million or more.

To ensure accurate claims processing, inpatient claims that exceed $10 million must be split into multiple submissions (interim claims), with each claim totaling less than $10 million and billed using the appropriate Type of Bill (TOB).

Failure to follow these requirements may result in processing delays or claim denials.

Billing REQUIREMENTS

Inpatient claims exceeding $10 million must be submitted using the following structure:

The First Interim Claim (TOB 112) must include the admission date through the current “through” date and must use discharge disposition code 30 (patient still a patient).
Subsequent Interim Claims (TOB 113) must include the admission date through the current “through” date and must use discharge disposition code 30 (patient still a patient).
Final Discharge Claim (TOB 114) must be submitted once the patient is discharged. This claim must include the full admission period (admission through discharge date) and must include the appropriate discharge disposition code (not code 30).

Providers are required to submit at least one first interim claim (TOB 112) and one final discharge claim (TOB 114).

KEY TAKEAWAY

Claims must be billed using the correct Type of Bill (TOB).
Interim claims must include all dates of service from admission through the current billing period.
Discharge disposition code 30 must be used on all interim claims.
The final claim must include the actual discharge disposition.

Action:

Providers are encouraged to share this information with their staff. If you have any questions about this notice, please email Provider Relations at ProviderRelations@cfhp.com or call 210-358-6030. You can also contact your Provider Relations Representative directly.

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