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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 already paid to the billing provider or another provider for this patient for the Date of Service entered. If there are two claims for the same or similar services, from two different providers, then the claim that gets processed first gets paid and any following claims get denied.
Solution:
Check to ensure the correct Billing Provider ID, Recipient ID, 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 already 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. Contact Provider Services to determine if another provider was paid. If another provider was paid you will have to contact that provider to coordinate the patient care. Enter the data in the loop and the segment provided, and resubmit.
| 837 Institutional |
BILLING PROVIDER:
Loop 2010AA, REF (Billing Provider Secondary Identification)
REF01 = 1D (Reference Identification Qualifier)
REF02 = Provider ID (Reference Identification)
Loop 2310C, REF (Other Provider Secondary Identification)
REF01 = 0B or 1D (Reference Identification Qualifier)
REF02 = Provider ID number or License Number (Reference Identification)
RECIPIENT ID:
Loop 2010BA, NM1 (Subscriber Name)
NM108 = MI (Identification Code Qualifier)
NM109 = Recipient ID number (Identification Code)
DATE OF SERVICE:
Loop 2300, DTP (Statement Dates)
DTP01 = 434 (Date/Time Qualifier)
DTP02 = D8 or RD8 (Date Time Period Qualifier)
DTP03 = Format CCYYMMDD or CCYYMMDD-CCYYMMDD (Date Time Period)
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
RATE CODE:
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)
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