Edit 01231

Inappropriate Rate Billed/Conflicting Claim Previously Paid

HIPAA Claim Adjustment Reason Code: 18
     Remark Code: N/A
HIPAA Healthcare Claim Status Code: 54
    Entity Identifier Code: N/A

Potential Causes:
The claim was already paid as a semi monthly first half and this claim is for semi monthly second half. Two semi monthly claims cannot be billed for the same recipient in the same month. The semi monthly billing is for when the patient enters the program late or leaves the program early. This edit can also mean the billing is for a monthly service and a semi monthly rate has already been paid.

Solution:
Check the Rate Code billed to ensure the correct Rate Code is on the claim. Verify previous billing for semi monthly and monthly payments. Enter the data in the loop and the segment provided, and resubmit.