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Edit 00901
Claim Type Unknown
HIPAA Claim Adjustment Reason Code: 16
Remark Code: N94
HIPAA Healthcare Claim Status Code: 145
Entity Identifier Code: 1P
Potential Causes:
The eMedNY processing system could not determine the type of claim submitted. All claims are processed according to the regulations and policies for the type of claim, such as Practitioner, Hospital Inpatient, etc.. For Clinic claims the system may not have derived the correct internal Category of Service. If a claim type cannot be determined, the claim cannot be processed and will fail edit 901.
Solution:
For Institutional (Rate-based) claims, verify the rate code, revenue code and bill type are correct for the claim. Check to ensure the date of service is correct for the revenue code/rate code combination.
For professional (procedure based) claims (physician etc…), check to ensure the procedure code is correct and active. Check to ensure the date of service is after the start date for the billing provider.
CALL THE CSC CALL CENTER IF FURTHER ASSISTANCE IS NECESSARY 800-343-9000.
| 837 Institutional |
Loop 2300
CLM (Claim Information)
CLM05-3 (Type of Bill)
- and -
HI (Value Information)
HI01-1 = BE (Code List Qualifier Code)
HI01-2 = 24 (Industry Code)
HI01-5 = 4 Digit Rate Code (Monetary Amount)
- and -
Loop 2400
SV2 (Institutional Service Line)
SV101 (Revenue Code)
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| 837 Professional |
Loop 2300
CLM (Claim Information)
CLM05-3 (Place of Service)
- and -
Loop 2400
SV1 (Professional Service Line)
SV101-2 (Procedure Code)
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