Edit 02053


Invalid NPI and MMIS Attending Provider ID Combination

HIPAA Claim Adjustment Reason Code: 208
    Remark Code: N253
HIPAA Healthcare Claim Status Code: 562
    Entity Identifier Code: N/A

Potential Causes:
The submitted Attending Physician NPI is not on the New York State NPI registration file as belonging to the same provider as the submitted Attending Physician MMIS Provider ID.

Solution:
Check to ensure the submitted NPI and MMIS Provider ID are correct for the Attending Physician. If the NPI and MMIS ID are correct, then the state registration file is incorrect. The provider must contact the NYS Medicaid Enrollment Unit at 800-342-3005.

837 Institutional

Loop 2310A NM1 (Attending Physician Name) NM109 (Attending Physician Primary Identifier) REF (Attending Physician Secondary Identification) REF02 (Attending Physician Additional Identifier) - or - Loop 2420A NM1 (Attending Physician Name) NM109 (Attending Physician Primary Identifier) REF (Attending Physician Secondary Identification) REF02 (Attending Physician Additional Identifier)