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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 was entered correctly. If billing for Medicare coinsurance days enter the days as Medicare Co-Insurance Days rather than Medicaid Full Days. Contact the Department of Social Services regarding the Recipient’s eligibility. Enter the data in the loop and the segment provided below and resubmit.
| 837 Porfessional |
Loop 2300, QTY (Claim Quantity)
QTY01 = CA (Medicaid Covered Actual) or CD (Co-Insurance Days)
QTY02 = Days Count (Quantity) |
See Accepted Reason Code: 30 in the MEVS provider manual.
F |
LIMITATIONS |
30 (Medicaid) |
MEDICARE COINSURANCE DEDUCTIBLE ONLY |
Client is eligible for payment of Medicare coinsurance and deductible only. Deductible and coinsurance payments will be made for Medicare approved services only. |
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