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Edit 01258
Service/End Service/Discharge Dates must be equal on a Graduate Medical Education (GME) Claim
HIPAA Claim Adjustment Reason Code: 16
Remark Code: MA31
HIPAA Healthcare Claim Status Code: 187
Entity Identifier Code: N/A
Potential Causes:
The Rate Code on the claim is for Graduate Medical Education (GME) and therefore the Discharge Date must also be entered as the From and Thru date of Service on GME claims.
Solution:
Check the Rate Code entered to ensure the correct Rate Code was used. Use the date the patient was discharged, as the Discharge Date and the date of Discharge should also be entered as From and Thru Date of Service when billing for Graduate Medical Education. Enter the data in the loop and the segment provided, and resubmit.
| 837 Institutional |
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)
And
Loop 2300, DTP (Statement Dates)
DTP01 = 434 (Date/Time Qualifier)
DTP02 = RD8 (Date Time Period Qualifier)
DTP03 = Format CCYYMMDD-CCYYMMDD (Date Time Period)
And
Loop 2300 HI (Occurrence Information)
HI01-1 = BH (Occurrence)
HI01-2 = 42 (Discharge Date)
And
Loop 2400, DTP (Service Line Date)
DTP01 = 472 (Date/Time Qualifier)
DTP02 = RD8 (Range of Dates Expressed in Format CCYYMMDD – CCYYMMDD)
DTP03 = Range of Dates |
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