Edit 02007


OMH PROS Rate Must be Billed on Last Day of Month

HIPAA Claim Adjustment Reason Code: 125
    Remark Code: N182
HIPAA Healthcare Claim Status Code: 187
    Entity Identifier Code: N/A

Potential Causes:
The rate code submitted for this claim indicates that this is an OMH PROS (Office of Mental Health – Personalized Recovery Oriented Services) claim. The claim failed edit 02007 because the Date of Service field must equal the last day of month.

Solution:
When the claim submitted is an OMH PROS claim, the Date of Service must be the last day of the month in which the services were rendered. The actual dates of service are not reported. Please review the loops and segments below, and re-submit the claim with the correct fields populated.

837 Institutional

Loop 2300, DTP (Statement Dates) DTP01 = 434 (Date/Time Qualifier) DTP02 = D8 (Date Time Period Qualifier) DTP03 = Statement Date - Format CCYYMMDD Loop 2300, HI (Value Information) HI01-1 = BE (Code List Qualifier Code) HI01-2 = 24 (Value Code) HI01-5 = 4 Digit Rate Code (Value Code Associated Amount - Rate Code) Loop 2400, DTP (Service Line Date) DTP01 = 472 (Date Time Qualifier) DTP02 = D8 (Date Time Period Format Qualifier) DTP03 = Service Date (Date Expressed in Format CCYYMMDD)