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Edit 00808
Patient Has Already Met Medicare Deductible - Review Medicare Data
HIPAA Claim Adjustment Reason Code: 23
Remark Code: M49
HIPAA Healthcare Claim Status Code: 122
Entity Identifier Code: N/A
Potential Causes:
The Medicare deductible is being claimed but other claim data is indicating the Medicare deductible is not due. There must be full Part A days in order to collect the Part A deductible.
Solution:
Check to ensure the Medicare Part A deductible is due. If it is not due then remove the entry and resubmit the claim. If the deductible is due then check to ensure there is at least one full Medicare Part A day on the claim. If all the days entered are Coinsurance days or Life Time Reserve days or a combination of both, the Part A deductible cannot be claimed. Confirm the data in the following locations. If they are correct the claim is not payable. Do not resubmit.
| 837 Institutional |
Loop 2300, QTY
QTY01=CD (Qualifier for Medicare Coinsurance Days)
QTY02= Medicare Coinsurance Days
- and/or both of the following two segments -
Loop 2300, QTY
QTY01=LA (Qualifier for Medicare Lifetime Reserve Days)
QTY02= Medicare Lifetime Reserve Days
Loop 2300, MIA
MIA02= Medicare Lifetime Reserve Days
- and -
Loop 2300, MIA
MIA01=Medicare Covered Days
- and -
Loop 2320, CAS
CAS01=PR (Qualifier for Patient Responsibility)
CAS02=1 (Deductible amount)
If all the Medicare Covered Days are Coinsurance Days or Lifetime Reserve Days the Deductible is not payable.
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