Edit 00848

Total Third Party Covered and Noncovered Days must equal Total Days In Billing Period

HIPAA Claim Adjustment Reason Code: 16
    Remark Code: MA32
HIPAA Healthcare Claim Status Code: 456
     Entity Identifier Code: N/A

Potential Causes:
The total number of days reported as covered by all entities involved in the claim does not equal the total number of days in the Statement Covers period (the from and thru Dates of Service). Also, if the Discharge Status Code is for Discharged/Transferred or Deceased, the system will calculate one day less than what is in the Statement Covers Period. Payment is not made for the day of Discharge/Transfer or Death.

Solution:
Check the number of days reported as covered for each of the entities involved in the claim. For Medicaid, check the number of days entered as covered and non-covered. Verify the Discharge Status code was entered correctly and subtract one day from the total covered days, if the status of the patient is Discharged/Transferred or Deceased. Check the Statement Covers Period to ensure the dates were entered correctly. Refer to the 837 Institutional Supplemental Companion Guide, Section 17. ”Other Payer Covered Days” for more information on NYSDOH requirements for other payer information. See Section 5., “Patient Status Codes” for more information on discharge status. Enter the data in the loop and the segment provided, and resubmit.