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Edit 00972
Recipient not authorized for Long Term Care for Service Period
HIPAA Claim Adjustment Reason Code: 16
Remark Code: N30
HIPAA Healthcare Claim Status Code: 109
Entity Identifier Code: QC
Potential Causes:
The Principle Provider File is not showing the recipient as being in the facility for the date of service billed.
Solution:
Please verify the Recipient ID and Date of Service. Correct if necessary. If both are correct, then contact the County Department of Social Services to correct the State Principle Provider File.
| 837 Institutional |
Loop 2010BA, NM1 (Subscriber Name)
NM108 = MI (Identification Code Qualifier)
NM109 = Recipient ID number (Identification Code)
And/or
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) |
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