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Edit 00700
PA Units or Payment Amount Exceeded
HIPAA Claim Adjustment Reason Code: 198
Remark Code: N/A
HIPAA Healthcare Claim Status Code: 483
Entity Identifier Code: N/A
Potential Causes:
The Dollar Amount or the Number of Units Available on the Prior Approval has been exceeded.
Solution:
Check the number of units/dollar amount on the claim to ensure that the correct number of units was entered. Using Medicaid remittances, research the number of units/dollar amount already paid for this Prior Approval. Enter the data in the loop and the segment provided, and resubmit.
Amount Charged:
| 837 Institutional, 837 Professional, and 837 Dental (Claim Level) |
Loop 2300, CLM (Claim Information)
CLM02 = Amount Charged (Monetary Amount) |
| 837 Institutional (Line Level) |
Loop 2400, SV2 (Institutional Service Line)
SV203 = Amount Charged |
| 837 Professional (Line Level) |
Loop 2400, SV1 (Professional Service)
SV102 = Amount Charged |
| 837 Dental (Line Level) |
Loop 2400, SV3 (Dental Service)
SV302 = Amount Charged |
Prior Approval and Units:
| 837 Institutional |
Loop 2300, REF (Prior Authorization or Referral Number)
REF01 = G1 (Prior Authorization Number)
REF02 = Prior Authorization Number
Loop 2400, SV2 (Institutional Service Line)
SV204 = Days or Units (Unit or Basis for Measurement Code)
SV205 = Quantity (Quantity)
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| 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
Loop 2400, SV1 (Professional Service)
SV104 = Enter the service unit count (Quantity)
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| 837 Dental |
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
Loop 2400, SV3 (Dental Service)
SV306 = The number of times the procedure was performed (Quantity) |
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