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Edit 00919
Invalid combination of Surface Codes
HIPAA Claim Adjustment Reason Code: 16
Remark Code: N75
HIPAA Healthcare Claim Status Code: 240
Entity Identifier Code: N/A
Potential Causes:
The surfaces indicated on the claim cannot be billed together.
Solution:
Check the surfaces indicated on the claim. Using the Medicaid Fee Schedule for Dental Procedure Codes, check to see what surface(s) associated with the procedure were entered on the claim. Verify the correct Procedure Code was billed. Enter the data in the loop and the segments provided, and resubmit.
| 837 Dental |
Loop 2400, SV3 (Dental Service) SV301-1 = AD (Product/Service ID Qualifier)
SV301-2 = Procedure Code (Product/Service ID)
And
Loop 2400, TOO (Tooth Information)
TOO03-1 = (Tooth Surface Code)
TOO03-2 = (Tooth Surface Code)
TOO03-3 = (Tooth Surface Code)
TOO03-4 = (Tooth Surface Code)
TOO03-5 = (Tooth Surface Code) |
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