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Edit 00803
Patient Born in Hospital / Year of Birth Differs from Admit Year
HIPAA Claim Adjustment Reason Code: 16
Remark Code:
N340
HIPAA Healthcare Claim Status Code: 158
Entity Identifier Code: QC
Potential Causes:
The Admission Type entered is 4 (Newborn), but the Admission Date differs from the Year of Birth. If the Admission Type is Newborn, then the Admission Date and the Date of Birth must be the same date.
Solution:
Check the Admission Type entered to ensure that the correct Admission Type was used. (If the patient was born elsewhere and then admitted to this Hospital on a day after the actual birthday, then the Admission type is not newborn.) Check the Admission Date entered to ensure the correct date was used. Verify the Date of Birth of the recipient using MEVS. If the Date of Birth on file is incorrect, contact the Department of Social Services. Enter the data in the loop and the segment provided, and resubmit.
| 837 Institutional |
Loop 2010BA, DMG (Subscriber Demographic Information)
DMG01 = D8 (Date Time Period Format Qualifier)
DMG02 = Recipient Date of Birth (Date Time Period)
And
Loop 2300, DTP (Admission Date/Hour)
DTP01 = 435 (Admission)
DTP02 = DT (Date and Time expressed in Format CCYYMMDDHHMM)
DTP03 = Admission Date and Hour
And
Loop 2300, CL1 (Institutional Claim Code)
CL101 = 4 (Admission Type Code) – Newborn |
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