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Edit 00843 HIPAA Claim Adjustment Reason Code: 23 Potential Causes: Solution: Review the Amounts reported on the claim for Medicare Part B payment amount, Other Insurance payment amount and or Patient Surplus amount. The processing system will subtract any one (or combination) of the above-mentioned entries from the value of the claim. If Medicare Part A covered the claim, check to ensure the proper value codes are entered for claiming the Deductible, Co-insurance or Life Time Reserve Amounts. If only Medicare Part B covered the claim, the Part B payment must be reported along with the Covered Days reported as Medicaid Covered Days. Check the number of days reported as Medicaid Covered and Medicaid non-Covered Days. If Medicare Part B paid more than Medicaid would have paid, then the claim will be denied for edit 843. If an Other Insurance Payment exceeds the Medicaid Value of the claim, then the claim cannot be billed to Medicaid. A claim can only be billed to Medicaid, if the Other Insurance paid less than Medicaid would have. If a recipient has a Surplus and the Surplus is not reported on the claim but appears on the recipient’s state file, the Surplus amount on file will be deducted from the claim. If that Surplus amount and/or any other insurance payments reported are greater than the Medicaid Value of the claim, the claim will deny for edit 843. Check MEVS to determine if a recipient has a Surplus Amount. Enter the data in the loop and the segment provided, and resubmit. Please refer to the 837 Institutional Supplemental Companion Guide on this site for further information on several of these data elements (www.nyhipaadesk.com). Lifetime Reserve Amounts and Surplus Amount:
Medicaid Covered and Non-Covered Days:
Deductible and Co-Insurance Amounts:
Medicare Part B Payments or Other Insurance Paid Amounts:
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