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Edit 01339
Recipient not authorized for Comprehensive Medicaid Case Management (CMCM) / Medicaid Service Coordination (MSC) on Service Date
HIPAA Claim Adjustment Reason Code: 16
Remark Code: N30
HIPAA Healthcare Claim Status Code: 88
Entity Identifier Code: QC
Potential Causes:
The Recipient is not on file as being authorized for Case Management Services for the Date of Service billed.
Solution:
Check the Recipient ID and Date of Service to ensure they are accurate. If correct then Contact the Local Department of Social Services to determine if it is possible to have the Recipient authorized for this Service. 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, DTP (Statement Dates)
DTP01 = 434 (Date/Time Qualifier)
DTP02 = D8 or RD8 (Date Time Period Qualifier)
DTP03 = Format CCYYMMDD or CCYYMMDD-CCYYMMDD (Date Time Period)
And
Loop 2400, DTP (Service Line Date)
DTP01 = 472 (Date/Time Qualifier)
DTP02 = D8 (Qualifier to indicate date)
= RD8 (Qualifier to indicate date range)
DTP03 = Service Date in the format CCYYMMDD (Date Time Period) |
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