Edit 00155

Recipient Age Less Than Minimum Primary Diagnosis

HIPAA Claim Adjustment Reason Code: 9
     Remark Code: N/A
HIPAA Healthcare Claim Status Code: 255
     Entity Identifier Code: N/A

Potential Causes:
The age of the patient is less than the minimum age associated with the Diagnosis Code entered?

Solution:
Check the Diagnosis Code entered to ensure it is the correct Diagnosis Code for this claim. Refer to the ICD 9 Coding Manual for age limitations on Diagnosis Codes. Check the Recipient ID Number to ensure the correct Recipient ID is being used. The age of the Recipient can be checked using MEVS. If the Birth Date of the Recipient is incorrect, then contact the Local Department of Social Services. Enter the data in the loop and the segment provided, and resubmit