Edit 02042


Referring MMIS Provider ID Cannot Be Derived

HIPAA Claim Adjustment Reason Code: 208
    Remark Code: N286
HIPAA Healthcare Claim Status Code: 562
    Entity Identifier Code: N/A

Potential Causes:
The referring provider’s MMIS Provider ID cannot be derived from the referring provider’s NPI. Claim processing requires the referring provider’s MMIS Provider ID when referral is involved.

Solution:
The NPI of the referring provider that was 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.

837 Institutional

Loop 2310C NM1 (Other Provider Name) NM109 (Other Physician Primary Identifier) - or - Loop 2420C NM1 (Other Provider Name) NM109 (Other Physician Primary Identifier)

837 Professional

Loop 2310A NM1 (Referring Provider Name) NM109 (Referring Provider Primary ID) - or - Loop 2420F NM1 (Referring Provider Name) NM109 (Referring Provider Primary ID)