Edit 00793

PART A DAYS WITH MEDICAID DAYS NOT ALLOWED ON A DRG CLAIM

HIPAA Claim Adjustment Reason Code: 16
            Remark Code: MA32
HIPAA Healthcare Claim Status Code: 456
            Entity Identifier Code: N/A

Potential Causes:
The rate code is for a DRG claim and there are days entered as both Medicare Part A days and Medicaid Full days. NYS Medicaid does not allow both Medicare Part A days and Medicaid Full days on a DRG claim.

Solution:
Check to ensure the correct rate code was used.  If the rate code is correct then check the days entered on the claim. Both entries are not allowed.  If Medicare exhausted during the stay, the Medicare non covered days are not billable days and should be reported as Medicaid non covered days.