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Edit 01226
Date Of Service (Day) For Office of Mental Retardation (OMR) Home and Community Based Service (HCBS) Waiver Semi-Monthly (Second-Half) Must Be Equal To “02”
HIPAA Claim Adjustment Reason Code: 16
Remark Code: M52
HIPAA Healthcare Claim Status Code: 187
Entity Identifier Code: N/A
Potential Causes:
The Rate Code used is for Semi Monthly Second Half and the Date of Service was not the second of the month. When billing for Semi Monthly Second Half the Date of Service must be the second of the month (example - 10/02/04)
Solution:
Check to ensure the correct Rate Code was used and the service is for Semi Monthly Second Half. If the Rate Code is correct, then change the Date of Service to be the second of the month, subsequent to the month the services were rendered. (Example – if the services were rendered in September and you are billing for the second half, then the Date of service would be 10/02/04.)
| 837 Institutional |
Loop 2300, DTP (Statement Dates)
DTP01 = 434 (Date/Time Qualifier)
DTP02 = D8 or RD8 (Date Time Period Qualifier)
DTP03 = Format CCYYMMDD or CCYYMMDD-CCYYMMDD (Date Time Period)
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) |
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