|
|
 |
Edit 00266
Recipient Age Greater Than Maximum for Procedure
HIPAA Claim Adjustment Reason Code: 6
Remark Code: N/A
HIPAA Healthcare Claim Status Code: 475
Entity Identifier Code: N/A
Potential Causes:
The age of the recipient is too old for the Procedure indicated on the claim.
Solution:
Please verify the date of birth and resubmit using the loop and segment provided. Also check the procedure code billed to insure correct procedure is entered.
| 837 Institutional |
Loop 2010BA, DMG (Subscriber Demographic Information)
DMG01 = D8 (Date Time Period Format Qualifier)
DMG02 = Recipient Date of Birth in CCYYMMDD format (Date Time Period)
And
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 2010BA, DMG (Subscriber Demographic Information)
DMG01 = D8 (Date Time Period Format Qualifier)
DMG02 = Recipient Date of Birth in CCYYMMDD format (Date Time Period)
And
Loop 2400, SV1 (Professional Service)
SV101-1 = HC (Product/Service ID Qualifier)
SV101-2 = Procedure Code (Product/Service ID) |
| 837 Dental |
Loop 2010BA, DMG (Subscriber Demographic Information)
DMG01 = D8 (Date Time Period Format Qualifier)
DMG02 = Recipient Date of Birth in CCYYMMDD format (Date Time Period)
And
Loop 2400, SV3 (Dental Service)
SV301-1 = AD (Product/Service ID Qualifier)
SV301-2 = Procedure Code (Product/Service ID) |
|
