Edit 00794

OUTLIER PAYMENT NOT ALLOWED FOR TRANSFERS

HIPAA Claim Adjustment Reason Code: 69
            Remark Code: MA43
HIPAA Healthcare Claim Status Code: 234
            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.