Edit 01107

Medical Assistance Coverage Code D Title XIX Days Present

HIPAA Claim Adjustment Reason Code: 16
    Remark Code: MA4
HIPAA Healthcare Claim Status Code: 286
     Entity Identifier Code: N/A

Potential Causes:
The recipient’s eligibility only allows payment if the claim is for the Medicare Co-Insurance, and the claim was for Medicaid Full Days.

Solution:
Check to ensure the Number of Days billed is correct. Enter the Days as Medicare Co-Insurance Days rather than Medicaid Full Days. Contact the Department of Social Services regarding the Recipients eligibility. Enter the data in the loop and the segment provided, and resubmit.