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Edit 90502
Denied per Medical Review By New York State Office of Health Systems Management (NYS OHSM)/Procedure Code Is Incorrect
HIPAA Claim Adjustment Reason Code: 16
Remark Code: N56
HIPAA Healthcare Claim Status Code: 454
Entity Identifier Code: DN
Potential Causes:
The Procedure Code billed was determined to be incorrect by NYS OHSM.
Solution:
Check the Procedure Code entered to ensure the correct procedure was used. Contact the New
York State Office of Health Systems Management. Enter the data in the loop and the segment
provided, and resubmit.
| 837 Institutional |
Loop 2300, HI (Principal Procedure Information) - (Inpatient of Clinic)
HI01-1 = BR (Code List Qualifier Code)
HI01-2 = Principal Procedure Code (Industry Code)
Or
Loop 2400, SV2 (Institutional Service Line) - (Non-Inpatient)
SV202-1 = HC (Product/Service ID Qualifier)
SV202-2 = Procedure Code – Enter HCPCS procedure code (Product/Service ID) |
| 837 Professional |
Loop 2400 SV1 (Professional Service)
SV107 -1 = Primary Diagnosis Code Pointer
Or
Loop 2400, SV1 (Professional Service)
SV101-1 = HC (Product/Service ID Qualifier)
SV101-2 = Procedure Code (Product/Service ID) |
| 837 Dental |
Loop 2400, SV3 (Dental Service)
SV301-1 = AD (Product/Service ID Qualifier)
SV301-2 = Procedure Code (Product/Service ID) |
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