Edit 00703

Inappropriate Second Service – Same Day

HIPAA Claim Adjustment Reason Code: 151
            Remark Code: M86
HIPAA Healthcare Claim Status Code: 259
            Entity Identifier Code: N/A

Potential Causes:
The same or similar service was previously paid to you or to another provider for this patient for the date(s) of service. If the patient went to two providers on the same day and received the same type of services, then the first claim processed is paid and any subsequent claims are denied.

Solution:

Check to ensure the correct Billing Provider ID (NPI), Recipient ID (CIN), Date of Service and Rate Code were entered correctly.

• If all the entries are correct, check the billing records at the Facility to determine if payment was previously made for this patient for the Date of Service under the same or a different Rate Code.
• If a payment was made under a different Rate Code, then both services cannot be billed for the same day.
• If no claim payment is found for the date of service, contact the eMedNY Call Center at 1-800-343-9000 to determine if another provider was paid.
• If another provider was paid, you will have to contact that provider to coordinate the patient’s care.

If a billing error caused the edit to be assigned, enter the corrected data in the loops and segments provided, and resubmit.