|
Edit 00264
Unlisted Services Procedure Code with Medicare Involvement
HIPAA Claim Adjustment Reason Code: 16
Remark Code: M51
HIPAA Healthcare Claim Status Code: 306
Entity Identifier Code: N/A
Potential Causes:
Billing with an unlisted Procedure Code, and Medicare is involved in the claim.
Solution:
The claim was billed with an unlisted procedure code with Medicare involvement. The claim should be billed with the same listed procedure code that was used on the Medicare claim.
| 837 Professional |
Loop 2400, SV1 (Professional Service)
SV101-1 = HC (Product/Service ID Qualifier)
SV101-2 = Procedure Code (Product/Service ID) |
| 837 Institutional |
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) |
|
