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Edit 00847
Billing For Deductible But No Medicare Days Present
HIPAA Claim Adjustment Reason Code: 16
Remark Code: MA32
HIPAA Healthcare Claim Status Code: 456
Entity Identifier Code: N/A
Potential Causes:
The CAS segment is indicating that the Medicare Part A Deductible is being billed, but the number of days covered by Medicare is not present.
Solution:
Verify that the Medicare Deductible is due. If the Deductible is due, then enter the number of Days covered by Medicare. If the Medicare Deductible is not due then remove the information in the CAS for the Part A Deductible. Enter the data in the loops and segments provided and resubmit.
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Claim Level
Loop 2320, CAS (Claim Adjustment)
CAS01 = PR (Claim Adjustment Group Code)
CAS02 = 1 (deductible) or 2 (co-insurance) (Claim Adjustment Reason Code)
CAS03 = Deductible/Co-insurance Amounts (Monetary Amount)
Or
Line Level
Loop 2430, CAS (Service Adjustment)
CAS01 = PR (Claim Adjustment Group Code)
CAS02 = 1 (deductible) or 2 (co-insurance) (Claim Adjustment Reason Code)
CAS03 = Deductible/Co-insurance Amounts (Monetary Amount)
And
Loop 2320, AMT (Payer Prior Payment)
Line Level
Claim Level
AMT01 = C4 (Amount Qualifier Code)
AMT02 = Medicare Paid Amount (Monetary Amount)
Or
Loop 2430, SVD (Line Adjudication Information)
SVD01 = Other Payer Identifier
SVD02 = Medicare Paid Amount (Monetary Amount)
And
Loop 2320, MIA (Medicare Inpatient Adjudication Information)
MIA01 = Other Payer Covered Days
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