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Edit 00039
Primary Diagnosis Code Blank
HIPAA Claim Adjustment Reason Code: 16
Remark Code: MA63
HIPAA Healthcare Claim Status Code: 254
Entity Identifier Code: N/A
Potential Causes:
A Primary Diagnosis Code is required and there was no diagnosis reported on the claim.
Solution:
Enter a Primary diagnosis code. For Professional Claims, check to ensure a diagnosis pointer was entered on the claim. Enter the data in the loop and the segments provided, and resubmit.
| 837 Institutional |
Loop 2300 HI (Principal, Admitting, E-Code and Patient Reason For Visit Diagnosis Information)
HI01-1 = BK (Principal Diagnosis)
HI01-2 = ICD-9-CM or 7999 |
| 837 Professional |
Loop 2300 HI (Health Care Diagnosis Code)
HI01-1 = BK (Principal Diagnosis)
HI01-2 = Principal Diagnosis
And
Loop 2400 SV1 (Professional Service)
SV107 -1 = Primary Diagnosis Code Pointer
Note: Diagnosis Code: NYSDOH expects to receive |
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