Edit 00126

Manual Review Code 6 Manual Price Excludes DME Equipment Service Area CD C & E

HIPAA Claim Adjustment Reason Code: 133
            Remark Code: N/A
HIPAA Healthcare Claim Status Code: 178
            Entity Identifier Code: N/A

Potential Causes:
The procedure code and other payment related fields indicated on the claim must be submitted on a paper claim form, as it requires review by the Department of Health before payment can be made.

Solution:
Please check your information and resubmit using a paper claim form.