Edit 02062


Transportation Service Performed during Inpatient Stay

HIPAA Claim Adjustment Reason Code: A1
    Remark Code: MA133
HIPAA Healthcare Claim Status Code: 54
    Entity Identifier Code: N/A

Potential Causes:
NYS files indicate the client as having an inpatient hospital stay for the Date of Service indicated on your claim. When transportation is required during a client’s inpatient stay, the transportation is considered included under the inpatient rate paid to the hospital.

Solution:
Check to ensure that the service date, the procedure code and the client ID submitted on your claim are correct. If any submitted fields are incorrect, then resubmit your claim using the loops and segments below correcting the data in error. If all the data is correct, then contact the hospital involved with the transportation for reimbursement.

837 Professional

Loop 2010BA, NM1 (Subscriber Name) NM108 = MI (Identification Code Qualifier) NM109 = Recipient ID number (Identification Code) Loop 2400, DTP (Date – Service Date) DTP01 = 472 (Date/Time Qualifier) DTP02 = D8 (Date Time Period Format Qualifier) DTP03 = Service Date in the format CCYYMMDD (Date Time Period) Loop 2400, SV1 (Professional Service) SV101-1 = HC (Product/Service ID Qualifier) SV101-2 = Procedure Code (Product/Service ID)