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Edit 02040
Billing MMIS Provider ID Cannot be Derived
HIPAA Claim Adjustment Reason Code: 208
Remark Code: N257
HIPAA Healthcare Claim Status Code: 562
Entity Identifier Code: N/A
Potential Causes:
The billing provider’s MMIS Provider ID cannot be derived from the billing provider’s NPI. Claim processing requires the MMIS Provider ID.
Solution:
The NPI entered on the claim is not on file with NYS Medicaid. Check the NPI used to ensure the correct NPI was entered on the claim. If the correct NPI was entered, contact the NYS Medicaid enrollment unit at 800-342-3005.
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837 Institutional, 837 Professional, 837 Dental
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Loop 2010AA
NM1 (Billing Provider Name)
NM109 (Billing Provider Primary Identifier)
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