Edit 01229

Office of Mental Retardation (OMR) Health and Community Based Services (HCBS) Waiver Rate Code Invalid for Recipient Exception Code

HIPAA Claim Adjustment Reason Code: A1
    Remark Code: M49
HIPAA Healthcare Claim Status Code: 463
    Entity Identifier Code: N/A

Potential Causes:
The recipient’s state file does not show the recipient approved for this program.

Solution:
Verify the recipient’s participation in the HCBC Waiver program using MEVS. If there is any problem with the Recipient coverage contact the Local Department of Social services.