|
|
 |
Edit 00137
Provider Inactive or Terminated
HIPAA Claim Adjustment Reason Code:B7
Remark Code: N/A
HIPAA Healthcare Claim Status Code: 91
Entity Identifier Code: 1P
Potential Causes:
The Category of Service derived by the system is not in an active status on the Provider Master File for the Date of Service billed.
Solution:
Verify that the Date of Service on the claim is correct. If the Date of Service is correct, contact Provider Services to determine the date the Category of Service is active. If there is a problem with the active date on the Provider Master file, contact the eMedNY Enrollment Unit.
To ensure the correct Category of Service was derived check the Rate Code, Type of Bill and Revenue Code (if Institutional Rate Based) or check the Procedure Code entered (if Fee Based). If you are unsure of the Type of Bill or Revenue Code, refer to either the 837 Institutional Supplemental Guide, and/or the Rate Code Crosswalk (both located at http://www.nyhipaadesk.com) or the Department of Health web site (http://www.health.state.ny.us/).
| 837 Institutional |
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)
And
Loop 2300, HI (Value Information)
HI01-1 = BE (Code List Qualifier Code)
HI01-2 = 24 (Industry Code)
HI01-5 = 4 Digit Rate Code (Monetary Amount)
And
Loop 2400, SV2 (Institutional Service Line) - (Non-Inpatient)
SV202-1 = HC (Product/Service ID Qualifier)
SV202-2 = Procedure Code – Enter HCPCS procedure code (Product/Service ID)
And
Loop 2400, DTP (Service Line Date)
DTP01 = 472 (Date/Time Qualifier)
DTP02 = D8 (Date Expressed in Format CCYYMMDD) or RD8 (Range of Dates Expressed in Format CCYYMMDD – CCYYMMDD)
DTP03 = Service Date or Range of Dates |
| 837 Professional |
Loop 2400, SV1 (Professional Service)
SV101-1 = HC (Product/Service ID Qualifier)
SV101-2 = Procedure Code (Product/Service ID)
And
48
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 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, SV3 (Dental Service)
SV301-1 = AD (Product/Service ID Qualifier)
SV301-2 = Procedure Code (Product/Service ID)
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) |
|
