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Edit 00030
Group ID Number Non-Numeric
HIPAA Claim Adjustment Reason Code: 16
Remark Code: MA112
HIPAA Healthcare Claim Status Code: 132
Entity Identifier Code: QV
Potential Causes:
The MMIS Group Identification Number entered on the claim is an incorrect/invalid ID Number.
Solution:
Check the Group Identification Number that was entered to ensure it was entered correctly. Verify the Group ID Number used is correct by calling the eMedNY Enrollment Unit. Enter the data in the loop and the segment provided, and resubmit
| 837 Dental and 837 Professional |
Loop 2010AB, NM1 (Pay-To-Provider’s Name)
NM101 = 87 (Pay to Provider)
NM108 = 24 (Employer’s Identification Number)
Or
NM108 = 34 (Social Security Number)
NM109 = (Employer’s Identification Number or Social Security Number
And
Loop 2010AB, REF (Pay-To-Provider Secondary Identification Number)
REF01 = 1D (Medicaid Provider Number)
REF02 = Medicaid Group ID Number
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