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Edit 00896
Patient Participation Not Greater Than Or Equal To Surplus Amount
HIPAA Claim Adjustment Reason Code: 16
Remark Code: N58
HIPAA Healthcare Claim Status Code: 122
Entity Identifier Code: N/A
Potential Causes:
When a Surplus Amount is reported, the amount must be repeated as the Patient Participation Amount. The amount reported as the Patient Participation Amount must be the same as, or more than, the amount reported as the Surplus Amount.
Solution:
Verify that a Surplus Amount is due from the patient. Check to ensure the correct Surplus Amount is entered as the Surplus Amount and the Patient Participation Amount. Enter the data in the loops and segments provided and resubmit.
| 837 Institutional |
Loop 2300, HI (Value Information)
HI01-1 = BE (Value)
HI01-2 = 22 ((Surplus Amount) (Value Code))
HI01-5 = Surplus Amount (Monetary Amount)
And
Loop 2300, HI (Value Information)
HI01-1 = BE (Value)
HI01-2 = 23 ((Patient Participation Amount) (Value Code))
HI01-5 = Patient Participation Amount (Monetary Amount)
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