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Edit 01278
Not a Traumatic Brain Injury (TBI) Recipient, TBI Services not reimbursable
HIPAA Claim Adjustment Reason Code: 16
Remark Code: N30
HIPAA Healthcare Claim Status Code: 109
Entity Identifier Code: QC
Potential Causes:
The Rate Code is for Traumatic Brain Injury, and the recipient’s state file is not coded to show the recipient as TBI.
Solution:
Check the Rate Code to ensure the correct Rate Code is entered. Verify the correct Recipient ID was entered on the claim. The status of the recipient as TBI can be checked using MEVS. If MEVS is not indicating the recipient as TBI (code 81) then contact the Local Department of Social Services regarding the status of the Recipient for TBI services. Enter the data in the loop and the segment provided, and resubmit.
| 837 Institutional |
Loop 2010BA, NM1 (Subscriber Name)
NM108 = MI (Identification Code Qualifier)
NM109 = Recipient ID number (Identification Code)
And
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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