Edit 02067


Attending Provider Not Linked to Billing Provider

HIPAA Claim Adjustment Reason Code: 208
    Remark Code: N55
HIPAA Healthcare Claim Status Code: 499
    Entity Identifier Code: N/A

Potential Causes:
The Attending Physician NPI is not on file with NYSDOH as affiliated with the Billing Provider.

The following Provider types are required to maintain Attending Provider Rosters, including out-of-state facilities.

0160 D&TCS: DIAGNOSTIC & TREATMENT CENTER SVCS (FSTNDG)
0260 HHAS: HOME HEALTH AGENCY PROFESSIONAL SVC (FSTNDG)
0285 HOS SVC: INPATIENT
0287 HOS SVC: HOSPITAL BASE OUTPATIENT SERVICES

Solution:
Using the Facility Affiliated Practitioner web site in eMedNY.org (or batch submission – see Companion Guides at NYHIPAADESK on eMedNY.org), the Attending Physician’s license number and NPI must be entered as affiliated with the Billing Provider.