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Edit 00707
Exact Duplicate Catch-all Procedure
HIPAA Claim Adjustment Reason Code: 18
Remark Code: N/A
HIPAA Healthcare Claim Status Code: 54
Entity Identifier Code: N/A
Potential Causes:
The Recipient ID on the claim and the Procedure Code on the claim are on file as already paid for that recipient and procedure. Most denials for this edit are manual denials by New York State.
Solution:
Check the procedure code and recipient ID to ensure the correct information was entered on the claim. Contact the Pend Resolution Unit at the New York State Department of Health or contact Provider Services. Otherwise, enter the data in the loop and the segment provided, and resubmit.
Procedure Code:
| 837 Institutional |
Loop 2300, HI (Principal Procedure Information) - (Inpatient of Clinic)
HI01-1 = BR (Code List Qualifier Code)
HI01-2 = Principal Procedure Code (Industry Code)
Or
Loop 2400, SV2 (Institutional Service Line) - (Non-Inpatient)
SV202-1 = HC (Product/Service ID Qualifier)
SV202-2 = Procedure Code – Enter HCPCS procedure code (Product/Service ID)
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| 837 Professional |
Loop 2400, SV1 (Professional Service)
SV101-1 = HC (Product/Service ID Qualifier)
SV101-2 = Procedure Code (Product/Service ID)
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Recipient ID:
| 837 Institutional, 837 Professional |
Loop 2010BA, NM1 (Subscriber Name)
NM108 = MI (Identification Code Qualifier)
NM109 = Recipient ID number (Identification Code) |
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