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Edit 01145
Principal Diagnosis Inconsistent With Psychiatric Exempt Unit Claim
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 is for Psychiatric Services, but the Diagnosis Code is not flagged by the state as being Psychiatric.
Solution:
Check the Rate Code and Diagnosis Codes to ensure the correct codes were used. If the correct Diagnosis Code(s) was entered, then change the Rate Code to be the appropriate Rate Code for the service billed. Enter the data in the loops and segments provided and resubmit.
| 837 Institutional |
Loop 2300 HI (Principal, Admitting, E-Code and Patient Reason For Visit Diagnosis Information)
HI01-1 = BK (Principal Diagnosis)
HI01-2 = ICD-9-CM or 7999
And
Loop 2300 HI (Other Diagnosis Information)
HI01-1 = BF (Other Diagnosis)
HI01-2 = ICD-9-CM or 7999
And
Loop 2300, HI (Value Information)
HI01-1 = BE (Code List Qualifier Code)
HI01-2 = 24 (Industry Code)
HI01-5 = 4 Digit Rate Code (Monetary Amount) |
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