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Edit 00510
Invalid CHAP Referral Code by Practitioner
HIPAA Claim Adjustment Reason Code: 16
Remark Code: N78
HIPAA Healthcare Claim Status Code: 460
Entity Identifier Code: N/A
Potential Causes:
The Procedure Code on the claim is a CHAP Procedure Code and there was no CHAP Referral Code on the claim OR there was a CHAP Referral Code for a procedure that was not a CHAP Procedure Code.
Solution:
Check the Procedure Code to see if the code is a CHAP code, if so, enter the CHAP Referral Code. If the Procedure Code is not CHAP then remove the CHAP Referral Code. Enter the data in the loop and the segment provided, and resubmit.
Valid delay indicator codes can be found in all 837 Supplemental Companion Guides on this site (www.nyhipaadesk.com).
| 837 Professional |
Loop 2300, CRC (EPSDT Referral)
And
Loop 2400, SV1 (Professional Service)
SV111 = Y (Yes/No Condition or Response Code) – EPSDT Indicator
And
Loop 2400, SV1 (Professional Service)
SV101-1 = HC (Product/Service ID Qualifier)
SV101-2 = Procedure Code (Product/Service ID)
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