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Edit 00186
Req PA For Procedure Not Found
HIPAA Claim Adjustment Reason Code: 197
Remark Code: N/A
HIPAA Healthcare Claim Status Code: 84
Entity Identifier Code: N/A
Potential Causes:
The Prior Approval Number is not on the Claim.
Solution:
For 837 Professional/Dental or certain Institutional Claims, a Prior Authorization (PA) Number is required whenever the Procedure Code is designated by the State as requiring PA. If a Procedure Code is designated as requiring PA then you must apply for a PA Number and the PA Number assigned must be entered on the claim. Enter the data in the loop and the segment provided, and resubmit.
| 837 Professional and Dental |
Loop 2300, REF (Prior Authorization or Referral Number)
REF01 = G1 (Prior Authorization Number)
REF02 = Prior Authorization Number
Or
Loop 2400, REF (Prior Authorization or Referral Number)
REF01 = G1 (Prior Authorization Number)
REF02 = Prior Authorization Number
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| 837 Institutional |
Loop 2300, REF (Prior Authorization or Referral Number)
REF01 = G1 (Prior Authorization Number)
REF02 = Prior Authorization Number |
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