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Edit 01162
Invalid Office of Mental Health Specialty / Rate Code Combination
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 on the claim is for Office of Mental Health (OMH) services but the Specialty Code derived is not for OMH Services.
Solution:
Check the Rate Code entered to ensure the correct Rate Code was used for the services rendered. Verify the correct Type of Bill and Revenue code was entered for an OMH claim. (Note: the Type of Bill for OMH claims must be 76.) If you are unsure of the Type of Bill or Revenue Code to use, refer to the 837 Institutional Supplemental Guide or the Rate Code Crosswalk (located at http://www.nyhipaadesk.com) or the Department of Health web site (http://www.health.state.ny.us/).
| 837 Institutional |
Loop 2300, CLM (Claim Information)
CLM05 -1 = Place of Service Code (Facility Code Value)
And
Loop 2300, HI (Value Information) - (Inpatient of Clinic)
HI01-1 = BE (Value)
HI01-2 = 24 (Value Code)
HI01-5 = four digit Rate Code (monetary amount)
And
Loop 2400, SV2 (Institutional Service Line)
SV201 = Service Line Revenue Code |
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