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Edit 00178
Procedure Invalid for Recipient Sex (Pend)
HIPAA Claim Adjustment Reason Code: 7
Remark Code: N/A
HIPAA Healthcare Claim Status Code: 474
Entity Identifier Code: N/A
Potential Causes:
The procedure billed is not valid for the patient’s gender.
Solution:
Please check the Procedure Code information and re-submit. Check the gender of the patient on file using the MEVS system. If the gender of the patient is incorrect on MEVS, contact the Department of Health.
| 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) |
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