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Edit / Error Knowledge Base > Select Edit Range > 00701 to 00800 >

Edit 00713

Recipient has Medicare Part B and Medicaid Other is blank

HIPAA Claim Adjustment Reason Code: 16
Remark Code: MA92
HIPAA Healthcare Claim Status Code: 463
Entity Identifier Code: N/A

Potential Causes:
The Recipient’s File is indicting the Recipient has Medicare Part B and the Medicare Part B coverage was not addressed on the claim.

Solution:
The Medicare Part B payment amount must be entered on the claim. If Medicare Part B did not cover the claim and the claim meets the “0FILL” criteria, then enter “0FILL” in SBR04. Refer to the 837 Institutional Supplemental Companion Guide located on this site (www.nyhippadesk.com, Section on Cost Avoidance Override / Zero Fill).
The Medicare coverage of the recipient can be checked using MEVS. If MEVS is showing Medicare Part B in error, contact the Local Department of Social Services

Depending on the situation, please use one of the following loops and segments combinations.

837 Institutional

Loop 2320, AMT (Payer Prior Payment)
AMT01 = C4 (Amount Qualifier Code)
AMT02 = Medicare Paid Amount (Monetary Amount)
Or
Loop 2430, SVD (Line Adjudication Information)
SVD01 = Other Payer Identifier
SVD02 = Medicare Paid Amount (Monetary Amount)

837 Professional

Loop 2000B, SBR (Subscriber Information)
SBR04 = 0FILL

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