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Edit 000785
Alternate Level Care (ALC) Claims Require an ALC Date
HIPAA Claim Adjustment Reason Code: 16
Remark Code: M52
HIPAA Healthcare Claim Status Code: 188
Entity Identifier Code: N/A
Potential Causes:
The Rate Code entered on the claim is for an Alternate Level of Care. When billing an Alternate Level of Care Rate Code, the Date, which the Alternate Level of Care started, is required.
Solution:
Check the Rate Code entered to ensure the correct Rate Code was used. Enter the date the Alternate Level of Care started. Enter the data in the loop and the segment provided, and resubmit.
| 837 Institutional |
Loop 2300, HI (Occurrence Span Information)
HI01-1 = BI (Occurrence Span)
HI01-2 = 75 (SNF Level of Care) (Occurrence Span Code)
HI01-3 = RD8 (Range of Dates expressed in Format CCYYMMDD-CCYYMMDD (Date Time Period)
HI01-4 = Occurrence or Occurrence Span Code Associated Date
And
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) |
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