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Edit 00974
Claim Provider ID Not Equal to Patient Participation File Provider For Part of the Service Period
HIPAA Claim Adjustment Reason Code: B7
Remark Code: N/A
HIPAA Healthcare Claim Status Code: 109
Entity Identifier Code: 1P
Potential Causes:
The Principle Provider File is not showing the recipient as being in the facility for only part of the time period billed.
Solution:
Please verify the Recipient ID, the Service Date, and the Billing Provider ID. Correct if necessary. If both are correct, then contact the County Department of Social Services to correct the State Principle Provider File. If not, enter the data in the loop and the segment provided, and resubmit.
| 837 Institutional |
Loop 2010AA, NM1 (Billing Provider Name)
NM101 = 85 (Pay to Provider)
NM108 = 24 (Employer’s Identification Number)
Or
NM108 = 34 (Social Security Number)
NM109 = (Employer’s Identification Number or Social Security Number
And
Loop 2010AA, REF (Billing Provider Secondary Identification Number)
REF01 = 1D (Medicaid Provider Number)
REF02 = Billing Provider ID Number
And
Loop 2010BA, NM1 (Subscriber Name)
NM108 = MI (Identification Code Qualifier)
NM109 = Recipient ID number (Identification Code)
And
Loop 2300, DTP (Statement Dates)
DTP01 = 434 (Date/Time Qualifier)
DTP02 = RD8 (Date Time Period Qualifier)
DTP03 = Format CCYYMMDD-CCYYMMDD (Date Time Period) |
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