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Edit 00866
Medicaid Coverage Code 10; Recipient Ineligible For This Service
HIPAA Claim Adjustment Reason Code: 16
Remark Code: N30
HIPAA Healthcare Claim Status Code: 109
Entity Identifier Code: QC
Potential Causes:
The Recipient’s coverage is for all services except Long Term Care and this claim is considered
Long Term Care by the state, therefore the coverage of the recipient does not include this type of
claim.
Solution:
The Rate Code is used to determine that the claim is for Long Term Care. Check the Rate Code
entered to ensure the correct Rate Code is being used. If the rate Code is correct, then the claim
is not a valid Medicaid claim for the coverage assigned to the patient. Contact the Local
Department of Social Services for information about the coverage assigned to the recipient. Enter
the data in the loop and the segment provided, and resubmit.
| 837 Institutional |
Loop 2300, HI (Value Information) - (Inpatient of Clinic)
HI01-1 = BE (Value)
HI01-2 = 24 (Value Code)
HI01-5 = four digit Rate Code (monetary amount)
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