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Edit 00199
Modifier Requires Manual Price
HIPAA Claim Adjustment Reason Code: 4
Remark Code: N/A
HIPAA Healthcare Claim Status Code: 453
Entity Identifier Code: N/A
Potential Causes:
The use of certain modifiers requires that the claim pend for Manual Pricing by the Department of Health.
Solution:
Check the Procedure Code and Modifier used to ensure they are correct. If they are correct and the claim is pending, then you should wait for the result of the Manual Review. If the claim was denied for edit 199, then contact the Department of Health. Enter the data in the loop and the segment provided, and resubmit.
| 837 Institutional, 837 Professional and 837 Dental |
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)
Loop 2400, SV2 (Institutional Service Line) - (Non-Inpatient)
SV202-3 = Procedure Modifier – Enter HCPCS procedure code modifier
SV202-4 = Procedure Modifier – Enter HCPCS procedure code modifier
SV202-5 = Procedure Modifier – Enter HCPCS procedure code modifier
SV202-6 = Procedure Modifier – Enter HCPCS procedure code modifier
Loop 2400, SV1 (Professional Service)
SV101-1 = HC (Product/Service ID Qualifier)
SV101-2 = Procedure Code (Product/Service ID)
Loop 2400, SV1 (Professional Service)
SV101-3 = Procedure Modifier – Enter HCPCS procedure code modifier
SV101-4 = Procedure Modifier – Enter HCPCS procedure code modifier
SV101-5 = Procedure Modifier – Enter HCPCS procedure code modifier
SV101-6 = Procedure Modifier – Enter HCPCS procedure code modifier
Loop 2400, SV3 (Dental Service)
SV301-1 = AD (Product/Service ID Qualifier)
SV301-2 = Procedure Code (Product/Service ID)
Loop 2400, SV3 (Dental Service)
SV303-3 = Procedure Modifier – Enter HCPCS procedure code modifier
SV303-4 = Procedure Modifier – Enter HCPCS procedure code modifier
SV303-5 = Procedure Modifier – Enter HCPCS procedure code modifier
SV303-6 = Procedure Modifier – Enter HCPCS procedure code modifier |
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