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Edit 00244
Prior Approval Number Not On or Removed From File
HIPAA Claim Adjustment Reason Code: 15
Remark Code: N/A
HIPAA Healthcare Claim Status Code: 252
Entity Identifier Code: N/A
Potential Causes:
There are two possible reasons why this claim was not processed. First, the prior approval number indicated on the claim was not on file at the time the claim was processed. Second, the procedure code indicated on the claim is not approved for use with the prior approval number indicated on the claim.
Solution:
Please verify that the Prior Approval Number is correct, and make sure the procedure code is correct for the Prior Approval number indicated on the claim. Please check your information in the loop and segments provided and re-submit.
| 837 Instutional |
Loop 2300: REF (Prior Authorization or Referral Number)
REF01 = G1 (Reference Identification Qualifier)
REF02 = Prior Approval Number (Reference Identification)
Loop 2300, HI (Principal Procedure Information) - (Inpatient of Clinic)
HI01-1 = BR (Code List Qualifier Code)
HI01-2 = Principal Procedure Code (Industry Code)
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 |
837 Professional |
Loop 2300, REF (Prior Authorization or Referral Number)
REF01 = G1 (Prior Authorization Number)
REF02 = Prior Authorization Number
Or
Lop 2400, REF (Prior Authorization or Referral Number)
REF01 = G1 (Prior Authorization Number)
REF02 = Prior Authorization Number
Loop 2400, SV1 (Professional Service)
SV101-1 = HC (Product/Service ID Qualifier)
SV101-2 = Procedure Code (Product/Service ID)
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| 837 Dental |
Loop 2300: REF (Prior Authorization or Referral Number)
REF01 = G1 (Reference Identification Qualifier)
REF02 = Prior Approval Number (Reference Identification)
Or
Loop 2400, REF (Prior Authorization or Referral Number)
REF01 = G1 (Prior Authorization Number)
REF02 = Prior Authorization Number
Loop 2400, SV3 (Dental Service)
SV301-1 = AD (Product/Service ID Qualifier)
SV301-2 = Procedure Code (Product/Service ID)
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