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Edit 00552
Claim Requires Prior Approval
HIPAA Claim Adjustment Reason Code: 197
Remark Code: N/A
HIPAA Healthcare Claim Status Code: 84
Entity Identifier Code: N/A
Potential Causes:
The claim submitted requires prior authorization.
Solution:
Please resubmit claim with a valid 11 digit Prior Approval Number using the loop and segment provided.
For 837 Professional Claims, a Prior Authorization number is expected whenever it is assigned.
| 837 Professional |
Loop 2300, REF (Prior Authorization or Referral Number)
REF01 = G1 (Prior Authorization Number)
REF02 = Prior Authorization Number
Loop 2400, REF (Prior Authorization or Referral Number)
REF01 = G1 (Prior Authorization Number)
REF02 = Prior Authorization Number
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