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Edit 00167
Recipient Age Less Than Minimum for Procedure (Pend)
HIPAA Claim Adjustment Reason Code: 6
Remark Code: N/A
HIPAA Healthcare Claim Status Code: 475
Entity Identifier Code: N/A
Potential Causes:
The patient is too young for the Procedure Code entered.
Solution:
Verify the correct Procedure Code was entered. Verify the age of the recipient using MEVS. If the correct Procedure Code was entered and the age of the recipient is correct then the claim cannot be billed. The patient is too young for the Procedure Code entered.
| 837 Institutional |
Loop 2300, HI (Principal Procedure Information) - (Inpatient of Clinic)
HI01-1 = BR (Code List Qualifier Code)
HI01-2 = Principal Procedure Code (Industry Code)
Or
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) |
| 837 Professional |
Loop 2400, SV1 (Professional Service)
SV101-1 = HC (Product/Service ID Qualifier)
SV101-2 = Procedure Code (Product/Service ID) |
| 837 Dental |
Loop 2400, SV3 (Dental Service)
SV301-1 = AD (Product/Service ID Qualifier)
SV301-2 = Procedure Code (Product/Service ID) |
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