How many occurrence code/date fields exist within FL 31-34 on the UB-04 form?

How many occurrence code/date fields exist within FL 31-34 on the UB-04 form?

• A. Two fields
• B. Eight fields
• C. Six fields
• D. Four identical fields

Answer: (D)

Four occurrence code/date blocks are provided in that section. Each block corresponds to one occurrence event and includes a space for the code and a space for the date, arranged in fields 31 through 34. This means you can record up to four separate occurrences, all following the same layout. The other options would imply fewer or more blocks, but the UB-04 specification uses exactly four identical occurrence code/date fields.

Four occurrence code/date blocks are provided in that section. Each block corresponds to one occurrence event and includes a space for the code and a space for the date, arranged in fields 31 through 34. This means you can record up to four separate occurrences, all following the same layout. The other options would imply fewer or more blocks, but the UB-04 specification uses exactly four identical occurrence code/date fields.