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Edit 01207
Care at Home Rate does not Match Recipients Program
HIPAA Claim Adjustment Reason Code: A1
Remark Code: N216
HIPAA Healthcare Claim Status Code: 84
Entity Identifier Code: N/A
Potential Causes:
The rate code (for Personal Care Agency or Home Health providers) or procedure code (for Nurse Registries) on the claim is for Care at Home Services but the client’s file is not indicating the client is in the Care at Home Program.
Solution:
Check the procedure code to ensure that the correct procedure code was billed. Check the rate code entered to ensure that the correct rate code was used. Verify with the Local Department of Social Services that the client is on file as Care at Home. Enter the data in the loops and segments provided, and resubmit.
| 837 Institutional |
Loop 2300, HI (Principal Procedure Information)
HI01-1 = BR (Code List Qualifier Code)
HI01-2 = Principal Procedure Code (Industry Code)
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)
Loop 2400, SV2 (Institutional Service Line)
SV202-1 = HC (Product/Service ID Qualifier)
SV202-2 = Procedure Code – Enter HCPCS procedure code (Product/Service ID)
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| 837 Professional |
Loop 2400, SV1 (Professional Service)
SV101-1 = HC (Product/Service ID Qualifier)
SV101-2 = Procedure Code (Product/Service ID)
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