Edit 01224

Invalid Diagnosis Code for Office of Mental Retardation (OMR) Health and Community Based Services (HCBS) Waiver Claim

HIPAA Claim Adjustment Reason Code: 16
    Remark Code: M52
HIPAA Healthcare Claim Status Code: 255
    Entity Identifier Code: N/A

Potential Causes:
The Diagnosis Code on the claim is not a designated Diagnosis Code for the HCBS Waiver program.

Solution:
Ensure the Diagnosis Code used is a Diagnosis Code designated by OMR for the HCBS Waiver Program. If additional information is needed for which Diagnosis Codes can be used, contact OMR. Enter the data in the loop and the segment provided, and resubmit.