|
Edit 02005
Nursing Home Transition and Diversion Medicaid Waiver (NHTD) Program Rate Code Requires Recipient with Exception Code 60
HIPAA Claim Adjustment Reason Code: 16
Remark Code: N30
HIPAA Healthcare Claim Status Code: 109
Entity Identifier Code: QC
Potential Causes:
The Recipient ID Number entered on the claim is not on file with exception code 60 for the dates of service billed, and the rate code used on the claim requires that the recipient has exception code 60 on file.
Solution:
Check to ensure that the rate code on the claim submitted is correct and that the claim is for NHTD services. Check to ensure the date of service is correct for the NHTD services.
Check the Recipient ID Number using MEVS to ensure the recipient is on file with exception code 60. If the recipient exception code is not 60 then you should call the Local Department of Social Services.
Enter the data in the loop and the segment provided, and resubmit.
| 837 Institutional |
RECIPIENT ID:
Loop 2010BA, NM1 (Subscriber Name)
NM108 = MI (Identification Code Qualifier)
NM109 = Recipient ID number (Identification Code)
STATEMENT DATES:
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)
RATE CODE:
Loop 2300, HI (Value Information)
HI01-1 = BE (Code List Qualifier Code)
HI01-2 = 24 (Industry Code)
HI01-5 = 4 Digit Rate Code (Value Code Associated Amount) (In this case – should be 4812)
|
|
