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Edit 00694
Date of Service Prior to Prepaid Capitation Plan (PCP) Begin Date
HIPAA Claim Adjustment Reason Code: 26
Remark Code: N52
HIPAA Healthcare Claim Status Code: 88
Entity Identifier Code: QC
Potential Causes:
The Date of Service is before the date that is on the patient’s file as the date they went into the 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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