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Edit 00172
Proc Requires Manual Pricing
HIPAA Claim Adjustment Reason Code: 16
Remark Code: M51
HIPAA Healthcare Claim Status Code: 306
Entity Identifier Code: N/A
Potential Causes:
The use of certain procedures requires that the claim pend for Manual Pricing by the Department
of Health.
Solution:
Check the Procedure Code used to ensure that it is correct. If it is correct and the claim is
pending, then you should wait for the result of the Manual Review. If the claim was denied for edit
00172, then contact the Department of Health. Enter the data in the loop and the segment
provided, and resubmit.
| 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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