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Edit / Error Knowledge Base > Select Edit Range > 01001 to 01100 >

Edit 01023

Hospital Leave Days not separate line

HIPAA Claim Adjustment Reason Code: 16
Remark Code: N63
HIPAA Healthcare Claim Status Code: 456
Entity Identifier Code: 80

Potential Causes:
There is a value in the Hospital Days field, but the Patient Status Code is not for Hospital Leave. Either the entry in the Hospital Day’s field is incorrect or the Patient Status is incorrect.

Solution:
Check the entry for the Hospital Leave Days and the Discharge Status Code of the Recipient to ensure they are correct. If billing for Hospital leave days the Discharge Status Code must reflect Hospital Leave. Enter the data in the loop and the segment provided, and resubmit.

Please note: For more information on Therapeutic/Hospital Days, please refer to Section 3., Revenue Codes in the 837 Institutional Supplemental Companion Guide on this site (www.nyhipaadesk.com).

Please note: Most Patient Status codes will be reported in Loop 2300, segment CL1, Institutional Claim Code. There are a few Patient Status codes that will be reported as Revenue Codes (Loop 2400, segment SV2, Institutional Service Line), or Occurrence Span Codes (Loop 2300, segment HI, Occurrence Span Information). In addition, there are several NYS Medicaid codes that have no direct map to the HIPAA values and will no longer be necessary. Please refer to the 837 Institutional Supplemental Guide located on this website (www.nyhipaadesk.com).

837 Institutional

Loop 2300 CL1 (Institutional Claim Code)
CL103 = Patient Status Code
And
Loop 2300 HI (Occurrence Span Codes)
HI01-1 = BI (Occurrence Span)
HI01-2 = Occurrence Span Code (If applicable for Patient Status Code)
And
Loop 2300 HI (Occurrence Information)
HI01-1 = BH (Occurrence)
HI01-2 = 42 (Discharge Date)
And
Loop 2400, SV2 (Institutional Service Line)
SV201 = Service Line Revenue Code (If applicable for Patient Status code)
And
Loop 2400, SV2 (Institutional Service Line)
SV205 = 0183 (Therapeutic Leave Days) or 0185 (Hospital Leave Days)

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