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Edit 00744
Diagnosis Code is not Valid for AIDS Rate Code
HIPAA Claim Adjustment Reason Code: 11
Remark Code: N/A
HIPAA Healthcare Claim Status Code: 255
Entity Identifier Code: N/A
Potential Causes:
The Rate Code entered on the claim is for an AIDS service but the Diagnosis Code entered is not for AIDS. Whenever an AIDS Rate Code is used, the Diagnosis Code must be the AIDS diagnosis code.
Solution:
Check the Rate Code entered to ensure the correct Rate Code was billed. Ensure the Diagnosis Code used is the AIDS Diagnosis code. Enter the data in the loop and the segment provided, and resubmit.
| 837 Institutional |
Loop 2300, HI (Value Information) - (Inpatient of Clinic)
HI01-1 = BE (Value)
HI01-2 = 24 (Value Code)
HI01-5 = four digit Rate Code (monetary amount)
And
Loop 2300 HI (Principal, Admitting, E-Code and Patient Reason For Visit Diagnosis Information)
HI01-1 = BK (Principal Diagnosis)
HI01-2 = ICD-9-CM or 7999 |
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