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Edit 02001
Claim Payer PD AMT Not Equal To Sum Of Line Payer PD AMT
HIPAA Claim Adjustment Reason Code: 125
Remark Code: N4
HIPAA Healthcare Claim Status Code: 400
Entity Identifier Code: N/A
Potential Causes:
The sum of the insurance payments from the line level must be equal to the total amount of the insurance payments entered on the header level. The eMedNY adjudication system adds all the insurance payments reported on the line level and compares the total amount to the total amount entered on the header level. If they do not match, the claim will fail edit 2001. (Note: The payments in question are for a prior payer).
Solution:
Check to ensure that the insurance payment entered on the header level is correct. Check the insurance payments on each service line and ensure that all the lines add up to equal the amount on the header. The lines must equal the header. Enter the data in the loop and the segments provided, and resubmit. (Note: The payments in question are for a prior payer).
| 837 Institutional, Professional and Dental |
Header level (Claim level):
Loop 2320, AMT (Coordination of Benefits, (COB) Payer Paid Amount
AMT01 = D (Payer Amount Paid)
AMT02 = Payer Paid Amount (Medicare or Other Insurance Paid Amount)
And
Line level:
2430 SVD, (Line Adjudication Information)
SVD01 = Other Payer Primary Identifier
SVD02 = Service Line (Medicare or Other Insurance) Paid Amount
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