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Edit 01039
Medicaid (Title XIX) Days Total Incorrect
HIPAA Claim Adjustment Reason Code: 16
Remark Code: MA32
HIPAA Healthcare Claim Status Code: 456
Entity Identifier Code: N/A
Potential Causes:
This edit will only affect the 837I. The number of days entered on the claim is not equal to the
number of days that we counted based on the dates of services. For clinic claims, the procedure
code was missing from the claim.
Solution:
Please make corrections to the following loop and segment and re-submit the claim.
| 837 Institutional |
Loop 2300, QTY (Claim Quantity)
QTY01 = CA (Quantity Qualifier)
QTY02 = Total Medicaid covered days (Quantity)
And
DTP02 = RD8 (Date Time Period Format Qualifier)
Loop 2300, DTP (Statement Dates)
DTP03 = Date Range Claimed (Date Time Period)
And
Loop 2400, SV2 (Institutional Service Line)
SV202-1 = HC (Product/Service ID Qualifier)
SV202-2 = HCPCS Procedure Code (Product/Service ID)) |
Note: The discharge status should also be checked in that all status codes indicating a discharge, transfer or death will cause the system to not count the last day in the billing period as a payable day. Loop 2300, CL1 (Institutional Claim Code) CL103 = Status code.
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