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Edit 00850
Medicare-A Co-Insurance Amount Present / Co-Insurance Days Missing
HIPAA Claim Adjustment Reason Code: 16
Remark Code: MA34
HIPAA Healthcare Claim Status Code: 458
Entity Identifier Code: N/A
Potential Causes:
A Co-Insurance Amount was reported but no Co-Insurance Days were entered.
Solution:
If claiming Medicare Co-Insurance then both the Coinsurance days and the Coinsurance amount must be entered. (The coinsurance amount is the number of coinsurance days times the coinsurance rate for the year billed). Enter the data in the loop and the segment provided, and resubmit.
| 837 Institutional |
Loop 2300 QTY (Claim Quantity)
QTY01 = CD (Co-Insurance Actual Medicare)
QTY02 = Number of Co-Insurance Days (Claim Days Count)
And
Loop 2320, CAS (Claim Adjustment)
CAS01 = PR (Claim Adjustment Group Code)
CAS02 = 2 (Co-Insurance) (Claim Adjustment Reason Code)
CAS03 = Co-insurance Amount (Monetary Amount) |
Note: the Claim Adjustment Group Code, Reason Code and Monetary Amount may be reported in any of CAS segments (at the line level) as defined in the CGs. The above is only an example.
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