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Edit 00289
Procedure Invalid For Sex Of Recipient
HIPAA Claim Adjustment Reason Code: 7
Remark Code: N/A
HIPAA Healthcare Claim Status Code: 474
Entity Identifier Code: N/A
Potential Causes:
The procedure reported on the claim is gender specific and does not match the gender that is on the recipient’s file.
Solution:
Verify that the correct Procedure Code was entered. Check the gender of the recipient using MEVS. If the gender of the recipient is incorrect on MEVS, contact the Local Department of Social Services to correct the recipient gender.
| 837 Institutional |
Loop 2300, HI (Principal Procedure Information) - (Inpatient of Clinic)
HI01-1 = BR (Code List Qualifier Code)
HI01-2 = Principal Procedure Code (Industry Code)
Or
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 2400, SV1 (Professional Service)
SV101-1 = HC (Product/Service ID Qualifier)
SV101-2 = Procedure Code (Product/Service ID) |
| 837 Dental |
Loop 2400, SV3 (Dental Service)
SV301-1 = AD (Product/Service ID Qualifier)
SV301-2 = Procedure Code (Product/Service ID) |
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