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Edit 01047
Date of Service Six Years Prior to Date Received
HIPAA Claim Adjustment Reason Code: 29
Remark Code: N/A
HIPAA Healthcare Claim Status Code: 187
Entity Identifier Code: N/A
Potential Causes:
The Date of Service on the claim was over six years old on the day of receipt, and claims cannot be submitted after six years from the Date of Service. This policy applies to all claims including adjustments/voids/originals and re-bills.
Solution:
Check the Date of Service to ensure the correct Date was entered. If the claim is over 6 years old contact the New York State Department of Health Two Year Review Unit regarding payment. Enter the data in the loop and the segments provided, and resubmit.
| 837 Institutional |
Loop 2300, DTP (Statement Dates)
DTP01 = 434 (Date/Time Qualifier)
DTP02 = D8 or RD8 (Date Time Period Qualifier)
Loop 2400, DTP (Service Line Date)
DTP03 = Format CCYYMMDD or CCYYMMDD-CCYYMMDD (Date Time Period)
And
DTP01 = 472 (Date/Time Qualifier)
DTP02 = D8 (Date Expressed in Format CCYYMMDD) or RD8 (Range of Dates Expressed in Format CCYYMMDD – CCYYMMDD)
DTP03 = Service Date or Range of Dates |
| 837 Professional |
Loop 2400, DTP (Date – Service Date)
DTP01 = 472 (Date/Time Qualifier)
DTP02 = D8 (Date Time Period Format Qualifier)
DTP03 = Service Date in the format CCYYMMDD (Date Time Period) |
| 837 Dental |
Loop 2300, DTP (Date – Service)
DTP01 = 472 (Date/Time Qualifier)
DTP02 = D8 (Date Time Period Format Qualifier)
DTP03 = Service Date in the format CCYYMMDD (Date Time Period)
And
Loop 2400, DTP (Date – Service)
DTP01 = 472 (Date/Time Qualifier)
DTP02 = D8 (Date Time Period Format Qualifier)
DTP03 = Service Date in the format CCYYMMDD (Date Time Period) |
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