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Edit 01002
Recipient Covered by Medicare Part-B; Re-Bill with Part-B Rate
HIPAA Claim Adjustment Reason Code: 16
Remark Code: M49
HIPAA Healthcare Claim Status Code: 463
Entity Identifier Code: N/A
Potential Causes:
The State Client File shows the client as having Medicare Part B and the provider did not bill with a Part B Rate Code.
Solution:
Rebill with the correct Rate Code or contact the Office of Medicaid Management if the Medicare coverage of the client is incorrect. Contact Provider Services if the Rate Code is correct and the coverage is correct. Enter the data in the loop and the segment provided, resubmit.
| 837 Institutional |
Loop 2300, HI (Value Information)
HI01-1 = BE (Value)
HI01-2 = 24 (Value Code)
HI01-5 = 4 Digit Rate Code (Value Code Associated Amount)
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