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Edit 00689
Recipient No Longer Prepaid Capitation Plan Enrollee
HIPAA Claim Adjustment Reason Code: 27
Remark Code: N52
HIPAA Healthcare Claim Status Code: 108
Entity Identifier Code: QC
Potential Causes:
The recipient is not on file as being in the Managed Care Plan.
Solution:
Check the Date of Service billed to ensure the correct date was entered. Contact the Department of Social Services regarding the status of the patient as Managed Care. Enter the data in the loop and the segment provided, and resubmit.
| 837 Institutional |
Loop 2300, DTP (Statement Dates)
DTP01 = 434 (Date/Time Qualifier)
DTP02 = RD8 (Date Time Period Qualifier)
DTP03 = Format CCYYMMDD-CCYYMMDD (Date Time Period)
And
Loop 2400, DTP (Service Line Date)
DTP01 = 472 (Date/Time Qualifier)
DTP02 = RD8 (Range of Dates Expressed in Format CCYYMMDD – CCYYMMDD)
DTP03 = Range of Dates |
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