Edit 00706

Stop-Loss Requires Manual Pricing

HIPAA Claim Adjustment Reason Code: 38
            Remark Code: N/A
HIPAA Healthcare Claim Status Code: 85
            Entity Identifier Code: N/A


Potential Causes:
The Rate Code submitted is for Managed Care Stop-Loss billing. These claims pend for manual pricing.

Solution:
If the correct Rate Code was submitted no further action is required.