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Edit 01131
Payments not allowed until Medicare/ Insurance is Maximized
HIPAA Claim Adjustment Reason Code: 22
Remark Code: N/A
HIPAA Healthcare Claim Status Code: 171
Entity Identifier Code: N/A
Potential Causes:
The Recipient’s File is showing that Medicare should still be paying the claim in full and therefore the claim cannot be billed to Medicaid.
Solution:
Check the Recipient ID number and Date of Service to ensure the correct entry is being made. If they are correct, then contact the Department of Social Services (DSS) District that the recipient is from. Medicaid payments are not allowed until the DSS enters an appropriate exception code on the State long-term care file. This exception code is provided on the monthly roster of patients distributed to the billing provider. Enter the data in the loop and the segment provided, and resubmit.
| 837 Institutional |
Loop 2010BA, NM1 (Subscriber Name)
NM108 = MI (Identification Code Qualifier)
NM109 = Recipient ID number (Identification Code)
And
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)
Loop 2400, DTP (Service Line Date)
DTP01 = 472 (Date/Time Qualifier)
DTP02 = D8 (Qualifier to indicate date)
= RD8 (Qualifier to indicate date range)
DTP03 = Service Date in the format CCYYMMDD (Date Time Period) |
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