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Edit 00717
Procedure Conflicts with Previous Service
HIPAA Claim Adjustment Reason Code: 18
Remark Code: M86
HIPAA Healthcare Claim Status Code: 54
Entity Identifier Code: N/A
Potential Causes:
This Claim Line conflicts with another Claim Line for the same service that was already paid on the same Remittance Advice or a previous Remittance Advice.
Solution:
Research previous payments received. Check Dates of Service and Procedure Codes to ensure the proper Procedure Code and date were billed. Enter the data in the loop and the segment provided, resubmit.
| 837 Institutional |
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)
And
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) |
| 837 Professional |
Loop 2400, DTP (Date – Service Date)
DTP01 = 472 (Date/Time Qualifier)
DTP02 = D8 (Date Time Period Format Qualifier)
And
DTP03 = Service Date in the format CCYYMMDD (Date Time Period)
Loop 2400, SV1 (Professional Service)
SV101-1 = HC (Product/Service ID Qualifier)
SV101-2 = Procedure Code (Product/Service ID) |
| 837 Dental |
Loop 2300, DTP (Date – Service)
DTP01 = 472 (Date/Time Qualifier)
DTP02 = D8 (Date Time Period Format Qualifier)
DTP03 = Service Date in the format CCYYMMDD (Date Time Period)
And
Loop 2400, SV3 (Dental Service)
SV301-1 = AD (Product/Service ID Qualifier)
SV301-2 = Procedure Code (Product/Service ID) |
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