|
|
 |
Edit 00218
Provider Not Approved for Service
HIPAA Claim Adjustment Reason Code: 4
Remark Code: N/A
HIPAA Healthcare Claim Status Code: 454
Entity Identifier Code: N/A
Potential Causes:
The procedure indicated on the claim cannot be billed with the category of service assigned to the claim.
Solution:
Please check your information in the loop and segments provided and re-submit. If you need additional help please see “Contact Us” in the announcement section of this website. (www.nyhipaadesk.com).
| 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)
|
Medicare Paid Amount:
| 837 Institutional |
Claim Level
Loop 2320, AMT (Payer Prior Payment)
AMT01 = C4 (Amount Qualifier Code)
AMT02 = Medicare Paid Amount (Monetary Amount)
Line Level 837
Loop 2430, SVD (Line Adjudication Information)
SVD01 = Other Payer Identification
SVD02 = Medicare Paid Amount (Monetary Amount)
|
| 837 Professional and 837 Dental |
Loop 2320, AMT (Coordination of Benefits (COB) Payer Paid Amount)
AMT01 = D (Payer Amount Paid)
AMT02 = Payer Paid Amount
Loop 2430, SVD (Service Line Adjudication Information)
SVD01 = Other Payer Identification
SVD02 = Medicare Paid Amount (Monetary Amount)
|
|
