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Edit 00144
Recipient Sex Not Equal File
HIPAA Claim Adjustment Reason Code: 16
Remark Code: MA39
HIPAA Healthcare Claim Status Code: 157
Entity Identifier Code: QC
Potential Causes:
The patient’s sex on the claim does not match the sex on the state file.
Solution:
The provider should double-check the Sex they have on the claim with the Sex on MEVS (Medicaid Eligibility Verification System) for this patient. If they do not have MEVS, then they should check it with local DSS (Department of Social Services). They should then make the necessary correction and resubmit the claim.
| 837 Institutional, 837 Professional, and 837 Dental |
Loop 2010BA, DMG (Subscriber Demographic Information)
DMG01 = D8 (Date Time Period Format Qualifier)
DMG02 = Recipient Date of Birth (Date Time Period)
DMG03 = Gender of recipient (F = female, M = male) (Gender Code) |
Note: A gender must be indicated. Medicaid does not recognize a gender of U (unknown).
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