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Edit 01343
Provider P.T. Clinic/P.T. Clinic Rate Not Billed
HIPAA Claim Adjustment Reason Code: 16
Remark Code: M49
HIPAA Healthcare Claim Status Code: 463
Entity Identifier Code: 1P
Potential Causes:
The Provider is billing with a Part Time Clinic Certification Number but the Rate Code assigned to the Part Time Clinic Provider is missing from the claim.
Solution:
The Provider needs to enter the Rate Code in HI01-5 in Loop 2300 and resubmit the claim. They should also ensure that the 13-digit Part Time Clinic Certification Number on their claim is correct. Please enter the data in the loops and segments provided.
| 837 Institutional |
Loop 2010AA (Billing Provider Secondary Identification)
REF01 = 1J (Facility ID Number) (Reference Identification Qualifier)
REF02 = Part Time Clinic Certification Number (Billing Provider Additional Identifier)
Loop 2300, HI (Value Information)
HI01-1 = BE (Code List Qualifier Code)
HI01-2 = 24 (Value Code)
HI01-5 = 4 Digit Rate Code (Value Code Associated Amount)
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