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Edit 00268
Recipient Age Less than Minimum 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 lower than the procedure code allows. The age of the patient is determined by the State file for the recipient.
Solution:
Please check the Procedure Code information and the age of the patient and re-submit. Enter the data in the loop and the segment provided, and resubmit.
| 837 Institutional, 837 Professional and 837 Dental |
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)
Loop 2400, SV1 (Professional Service)
SV101-1 = HC (Product/Service ID Qualifier)
SV101-2 = Procedure Code (Product/Service ID)
Loop 2400, SV3 (Dental Service)
SV301-1 = AD (Product/Service ID Qualifier)
SV301-2 = Procedure Code (Product/Service ID) |
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