Edit 01220

Day Treatment Rate Invalid for Principle Provider Code

HIPAA Claim Adjustment Reason Code: 8
            Remark Code: M49
HIPAA Healthcare Claim Status Code: 109
            Entity Identifier Code: GY

Potential Causes:
The Rate Code on the claim is indicating Day Treatment Services and the Principle Provider File is not showing the recipient as being in a Day Treatment program.

Solution:
Check the Rate Code to ensure that it is entered correctly. If the Rate Code is correct, then contact the Local Department of Social Services to have the Recipient placed on the Principle Provider File. Enter the data in the loop and the segment provided, and resubmit.