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Edit 00971
Recipient not authorized for Long Term Care for part of Service Period
HIPAA Claim Adjustment Reason Code: 16
Remark Code: N30
HIPAA Healthcare Claim Status Code: 109
Entity Identifier Code: QC
Potential Causes:
The Principal Provider File is not showing the Recipient as Authorized for Long Term Care for Part of the Time period being billed.
Solution:
Check the Date of Service to ensure the correct dates were billed. Refer to your Nursing Home Roster to ensure the Recipient is listed on the roster. Contact the Local Department of Social Services about the status of the recipient for Long Term Care Services. Enter the data in the loop and the segment provided, and resubmit.
| 837 Institutional |
Loop 2300, DTP (Statement Dates)
DTP01 = 434 (Date/Time Qualifier)
DTP02 = RD8 (Date Time Period Qualifier)
DTP03 = Format CCYYMMDD-CCYYMMDD (Date Time Period)
And
Loop 2400, DTP (Service Line Date)
DTP01 = 472 (Date/Time Qualifier)
DTP02 = RD8 (Range of Dates Expressed in Format CCYYMMDD – CCYYMMDD)
DTP03 = Range of Dates |
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