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Edit 00204
Procedure Code Inactive on Service Date
HIPAA Claim Adjustment Reason Code: 181
Remark Code: N/A
HIPAA Healthcare Claim Status Code: 486
Entity Identifier Code: N/A
Potential Causes:
The Procedure Code that was submitted was not valid for the Date of Service indicated.
Solution:
Resubmit bill with a Procedure Code that was available on the Date of Service. Please resubmit using the loops and segments provided.
| 837 Institutional |
Loop 2300, HI (Principal Procedure Information)
HI01-1 = BR (Code List Qualifier Code)
HI01-2 = Principal Procedure Code (Industry Code)
Loop 2300, DTP (Statement Dates)
DTP01 = 434 (Date/Time Qualifier)
DTP02 = D8 or RD8 (Date Time Period Qualifier)
DTP03 = Format CCYYMMDD or CCYYMMDD-CCYYMMDD (Date Time Period)
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| 837 Professional |
Loop 2400, SV1 (Professional Service)
SV101-1 = HC (Product/Service ID Qualifier)
SV101-2 = Procedure Code (Product/Service ID)
Loop 2400, DTP (Date – Service Date)
DTP01 = 472 (Date/Time Qualifier)
DTP02 = D8 (Date Time Period Format Qualifier)
DTP03 = Service Date in the format CCYYMMDD (Date Time Period) |
| 837 Dental |
Loop 2400, SV3 (Dental Service)
SV301-1 = AD (Product/Service ID Qualifier)
SV301-2 = Procedure Code (Product/Service ID)
Loop 2300, DTP (Date – Service)
DTP01 = 472 (Date/Time Qualifier)
DTP02 = D8 (Date Time Period Format Qualifier)
DTP03 = Service Date in the format CCYYMMDD (Date Time Period)
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