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Edit 00970
Recipient Not Authorized on Principal Provider System
HIPAA Claim Adjustment Reason Code: 16
Remark Code: N30
HIPAA Healthcare Claim Status Code: 109
Entity Identifier Code: QC
Potential Causes:
This edit will only affect the 837I. Principal Provider file is not showing this patient as being in this
facility for the time period they are billing for on this claim.
Solution:
Please check the dates of service in the following loop and segments and if they are correct then contact the county Department of Social Services (DSS) office to update or correct the state file.
| 837 Institutional |
Loop 2300, DTP (Statement Dates)
DTP01 = 434 (Date/Time Qualifier)
DTP02 = D8 or RD8 (Date Time Period Qualifier)
DTP03 = Format CCYYMMDD or CCYYMMDD-CCYYMMDD (Date Time Period)
Or
Loop 2400, DTP (Service Line Date)
DTP01 = 472 (Date/Time Qualifier)
DTP02 = D8 or RD8 (Date Time Period Format Qualifier)
DTP03 = Service Date/Range (Date Time Period) |
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