Edit 01191

Outpatient Psychiatric Rate Billed for Recipient in a Residential Health Care Facility

HIPAA Claim Adjustment Reason Code: 16
    Remark Code: M97
HIPAA Healthcare Claim Status Code: 585
    Entity Identifier Code: N/A

Potential Causes:
The patient is on file as being in a Residential Health Care Facility and the service billed is covered by that Facility.

Solution:
Check to ensure that the correct Rate Code was billed. If the correct Rate Code was billed then contact the Department of Social Services to determine what Residential Health Care Facility the patient is in then contact that facility for payment. Enter the data in the loops and segments provided and resubmit.