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Edit 00672
Family Planning Indicator Invalid for Billing Provider
HIPAA Claim Adjustment Reason Code: 170
Remark Code: M44
HIPAA Healthcare Claim Status Code: 460
Entity Identifier Code: N/A
Potential Causes:
The Condition Code for Family Planning services was entered on the claim, but the Specialty Code derived is not a Specialty Code that can be used for Family Planning Services.
Solution:
Verify that Family Planning was part of the service rendered. If Family Planned Services were not rendered as part of the visit then remove the Family Planning Condition Code. Check to ensure that the correct Rate Code, Type of Bill and Revenue Code were entered on the claim. (These entries determine the Category of Service and/or Specialty Code.) Enter the data in the loop and the segments provided, and resubmit. If you are unsure of the Type of Bill or Revenue Code to use, refer to the 837 Institutional Supplemental Guide or the Rate Code Crosswalk located at http://www.nyhipaadesk.com).
| 837 Institutional |
Loop 2300, REF (Service Authorization Exception Code)
REF01 = 4N (Reference Identification Qualifier)
REF02 = 7 (Reference Identification)
And
Loop 2300, HI (Value Information) - (Inpatient of Clinic)
HI01-1 = BE (Value)
HI01-2 = 24 (Value Code)
HI01-5 = four digit Rate Code (monetary amount)
And
Loop 2300, HI (Condition Information)
HI01-1 = BG (Condition)
HI01-2 = Condition Code (NUBC code list)
And
Loop 2400, SV2 (Institutional Service Line)
SV201 = 0240 (Service Line Revenue Code)
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