Edit 00148

Secondary Diagnosis Not on File

HIPAA Claim Adjustment Reason Code: 16
     Remark Code: M64
HIPAA Healthcare Claim Status Code: 255
     Entity Identifier Code: N/A

Potential Causes:
If the claim submitted is for Inpatient services, then the Admitting Diagnosis Code is not valid.

Solution:
Check the Diagnosis Code entered to ensure the correct code was used for this claim. Refer to the ICD 9 Diagnosis Code Manual to ensure the Code entered is a valid Diagnosis Code. Medicaid requires the use of a 4th or 5th digit sub-classification when one is available. Enter the data in the loop and the segment provided, and resubmit.