Edit 02071


Ordering MMIS Provider ID Cannot Be Derived

HIPAA Claim Adjustment Reason Code: 208
    Remark Code: N265
HIPAA Healthcare Claim Status Code: 562
    Entity Identifier Code: DK

Potential Causes:
The Ordering Provider MMIS Provider ID cannot be derived from the submitted Ordering Provider NPI.

Solution:
The submitted Ordering Provider NPI is not on file with NYS Medicaid. Check the NPI used to ensure the correct NPI was entered on the claim. If the submitted NPI is correct, contact the NYS Medicaid enrollment unit at 518-402-7032.

837 Professional

Loop 2420E NM1 (Ordering Provider Name) NM109 (Ordering Provider Primary Identifier)