Edit 01209

Designated Mental Illness Diagnosis Required

HIPAA Claim Adjustment Reason Code: 12
            Remark Code: N/A
HIPAA Healthcare Claim Status Code: 255
            Entity Identifier Code: N/A

Potential Causes:
All Mental Health Clinic claims must have a Diagnosis Code that is designated by the Office of Mental Health as a Mental Health Diagnosis.

Solution:
Verify that the correct Diagnosis Code was entered on the claim. For a list of valid mental health Diagnosis Codes contact the Office of Mental Health. Enter the data in the loop and the segments provided, and resubmit.