|
Edit 00245
Prior Approval Indicated Not Approved by NYS
HIPAA Claim Adjustment Reason Code: 39
Remark Code: N/A
HIPAA Healthcare Claim Status Code: 252
Entity Identifier Code: N/A
Potential Causes:
New York State denied the request for Prior Approval Number issued to the provider.
Solution:
Verify the Prior Approval entered was the correct Prior Approval for the claim. Contact the Prior Approval office as to why the Prior Approval was denied. Enter the data in the loop and the segments provided, and resubmit.
| 837 Institutional |
Loop 2300, REF (Prior Authorization or Referral Number)
REF01 = G1 (Reference Identification Qualifier)
REF02 = Prior Approval number (Reference Identification) |
| 837 Professional |
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
|
| 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
|
|
