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Edit 000789
Statement FROM Date Not Equal ADMIT Date for DRG Claim
HIPAA Claim Adjustment Reason Code: 16
Remark Code: M52
HIPAA Healthcare Claim Status Code: 187
Entity Identifier Code: N/A
Potential Causes:
For all DRG claims (Rate Code 2946, 2953, 2956 and 2958) the Beginning Date of Service must be the same as the Admission Date. If billing an Outlier Claim (Rate Code 2956 or 2958), then the Beginning Date of Service must be after the Admission Date.
Solution:
Check to ensure that the correct Rate Code is used for the claim. If the claim is an Outlier claim, change the rate to be 2956 – (In-State-Outlier), or 2958 – (Out-of-State-Outlier). If billing for a DRG Inlier claim (Rate Code 2946, In-State or 2953, Out-of-State) then the Admission Date and from Date of Service must be the same date. Check the dates used and make the necessary correction.
| 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)
Loop 2300, DTP (Admission Date/Hour)
DTP01 = 435 (Admission)
DTP02 = DT (Date and Time expressed in Format CCYYMMDDHHMM)
DTP03 = Admission Date and Hour
Loop 2300, HI (Value Information)
HI01-1 = BE (Code List Qualifier Code)
HI01-2 = 24 (Industry Code)
HI01-5 = 4 Digit Rate Code (Monetary Amount)
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