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Edit 00727
Claim Duplicates Same or Similar Service Paid to You or Another Provider
HIPAA Claim Adjustment Reason Code: 18
Remark Code: N/A
HIPAA Healthcare Claim Status Code: 54
Entity Identifier Code: N/A
Potential Causes:
We already paid this provider or another provider for this patient for the same or overlapping dates of service.
Solution:
Please check your dates of service to be sure they are correct. The dates of service are found in the following loop and segments.
| 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)
Or
Loop 2400, DTP (Service Line Date)
DTP01 = 472 (Date/Time Qualifier)
DTP02 = D8 or RD8 (Date Time Period Format Qualifier)
DTP03 = Service Date/Range (Date Time Period) |
| 837 Professional |
Loop 2400, DTP (Date – Service Date)
DTP01 = 472 (Date/Time Qualifier)
DTP02 = D8 (Date Time Period Format Qualifier)
DTP03 = Service Date in the format CCYYMMDD (Date Time Period) |
| 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)
Or
Loop 2400, DTP (Date - Service)
DTP01 = 472 (Date/Time Qualifier)
DTP03 = Service Date in the format CCYYMMDD (Date Time Period)
DTP02 = D8 (Date Time Period Format Qualifier) |
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