|
Edit 01249
Consecutive Theraputic Days Greater Than 4 For RTF Claim, No
Prior Authorization Present
HIPAA Claim Adjustment Reason Code: 151
Remark Code: N/A
HIPAA Healthcare Claim Status Code: 48
Entity Identifier Code: N/A
Potential Causes:
Therapeutic Treatment Days involve a leave from a Residential Treatment Facility (RTF) to an Acute Care Hospital. A maximum of 4 days are payable unless a Prior Authorization is obtained.
Solution:
Obtain a Prior Authorization Number for the Therapeutic Treatment Days and resubmit the claim with the PA number in the location shown below.
| 837 Institutional |
Loop 2300, REF (Prior Authorization or Referral Number)
REF01=G1 (Reference Identification Qualifier)
REF02= Prior Authorization Number
|
|
