Edit 00102

Service Date Prior to Birth Date

HIPAA Claim Adjustment Reason Code: 14
     Remark Code: N/A
HIPAA Healthcare Claim Status Code: 158
     Entity Identifier Code: QC

Potential Causes:
The Date of Service is before the Birth Date of the recipient on the State Recipient File.

Solution:
Check the Date of Service on the claim to ensure it is correct. Using the MEVS System, check the Date of Birth of the recipient. If it is correct, then the Recipient file may have been updated since the claim was denied and you should resubmit the claim. If the Date of Birth is incorrect, then contact the Local Department of Social Services about the correct Date of Birth. Enter the data in the loop and the segment provided, and resubmit.

837 Institutional

Loop 2010BA, DMG (Subscriber Demographic Information) DMG01 = D8 (Date Time Period Qualifier) DMG02 = Subscriber Birth Date in the format CCYYMMDD - and - Loop 2300, DTP (Statement Dates) DTP01 = 434 (Date/Time Qualifier) DTP02 = D8 or RD8 (Date Time Period Qualifier) DTP03 = Statement Dates in the format CCYYMMDD or CCYYMMDD-CCYYMMDD (Date Time Period) - and - Loop 2400, DTP (Service Line Date) DTP01 = 472 (Date/Time Qualifier) DTP02 = D8 (Qualifier to indicate date) = RD8 (Qualifier to indicate date range) DTP03 = Service Date in the format CCYYMMDD (Date Time Period)

837 Professional

Loop 2010BA, DMG (Subscriber Demographic Information) DMG01 = D8 (Date Time Period Qualifier) DMG02 = Subscriber Birth Date in the format CCYYMMDD - and - 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)

837 Dental

Loop 2010BA, DMG (Subscriber Demographic Information) DMG01 = D8 (Date Time Period Qualifier) DMG02 = Subscriber Birth Date in the format CCYYMMDD - and - Loop 2300, DTP (Date-Service) DTP01 = 472 (Date/Time Qualifier) DTP02 = D8 (Date Time Period Format Qualifier) DTP03 = Service Date in the format CCYYMMDD (Date Time Period) - and - Loop 2400, DTP (Date-Service) DTP01 = 472 (Date/Time Qualifier) DTP02 = D8 (Date Time Period Format Qualifier) DTP03 = Service Date in the format CCYYMMDD (Date Time Period)