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Edit 01046
Rate Not Available For Service Period
HIPAA Claim Adjustment Reason Code: 16
Remark Code: M49
HIPAA Healthcare Claim Status Code: 463
Entity Identifier Code: N/A
Potential Causes:
The Rate Code entered on the claim is not on file for the From and Thru Date of Service entered on the claim.
Solution:
Check the Rate Code used to ensure the correct Rate Code was entered. Verify the From and Thru Date of Service is correct. If both the Rate Code and Date of Service are correct then contact the Department of Health Enrollment Unit to update the service period on file for the Rate Code used. Enter the data in the loop and the segment provided, and resubmit.
| 837 Institutional |
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)
Or
Loop 2400, DTP (Service Line Date)
DTP01 = 472 (Date/Time Qualifier)
DTP02 = RD8 (Range of Dates Expressed in Format CCYYMMDD – CCYYMMDD)
DTP03 = Range of Dates
And
Loop 2300, HI (Value Information) - (Inpatient of Clinic)
HI01-1 = BE (Value)
HI01-2 = 24 (Value Code)
HI01-5 = four digit Rate Code (monetary amount) |
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