|
Edit 02003
Provider Not Certified For This Procedure
HIPAA Claim Adjustment Reason Code: B7
Remark Code: N/A
HIPAA Healthcare Claim Status Code: 91
Entity Identifier Code: N/A
Potential Causes:
The Billing Provider was not certified by the Office of Mental Health (OMH) to be paid for this procedure (J2794 - Risperdal Consta) for the Date of Service on the claim.
Solution:
Check to ensure the Billing Provider is the correct ID number for a Risperdal Consta claim. Please ensure that the Date(s) of Service submitted fall(s) within the Begin and End Date(s) of the Provider’s Certification for Risperdal Consta. Additionally, ensure that the correct Procedure Code was entered. Enter the data in the loops and the segments provided, and resubmit. If the Date of Service, Procedure Code and Provider ID are correct, contact OMH regarding the information on file for the certification in the Risperdal Consta Program.
| 837 Institutional |
Loop 2300, DTP (Statement Dates)
DTP01 = 434 (Date/Time Qualifier)
DTP02 = D8 or RD8 (Date Time Period Qualifier)
DTP03 = Format CCYYMMDD or CCYYMMDD-CCYYMMDD (Date Time Period)
Loop 2400, SV2 (Institutional Service Line)
V202-1 = HC (Product/Service ID Qualifier)
SV202-2 = Procedure Code – Enter HCPCS procedure code (Product/Service ID)
|
| 837 Professional |
Loop 2400, SV1 (Professional Service)
SV101-1 = HC (Product/Service ID Qualifier)
SV101-2 = Procedure Code (Product/Service ID)
Loop 2400, DTP (Date – Service Date)
DTP01 = 472 (Date/Time Qualifier)
DTP02 = D8 (Date Time Period Format Qualifier)
DTP03 = Service Date in the format CCYYMMDD (Date Time Period)
|
|
