|
Edit 00795
Cost Outlier Requires Manual Pricing
HIPAA Claim Adjustment Reason Code: 70
Remark Code: N/A
HIPAA Healthcare Claim Status Code: 42
Entity Identifier Code: N/A
Potential Causes:
A Condition Code of 61 was sent in the HI – Condition Information segment in loop 2300. This condition code is used to indicate that the claim should be considered for manual review and pricing by DOH because the Inpatient cost lies outside the normal DRG reimbursement.
Solution:
Unless the Condition Code of 61 was sent in error no action is required. The claim will pend for manual review.
|
