Edit 00062

Service Provider ID Number Invalid

HIPAA Claim Adjustment Reason Code: 38
            Remark Code: N291
HIPAA Healthcare Claim Status Code: 153
            Entity Identifier Code: SJ

Potential Causes:
The Service Provider ID Number is less than 8 digits or the segment was left blank.  The problem may be that the number submitted is a License Number but the Profession Code field was left blank.

Solution:
Verify that the claim was submitted with the qualifier 1D if an MMIS Provider ID was entered as a Service Provider ID Number. Also, please ensure that the number entered is 8 digits in length. If a license number was entered then follow the instructions below:

License Number Note:
837 Institutional:
The entry of a License Number requires a three-character Profession Code and, depending on the claim type, two zeros to precede the License Number.
837 Professional:
When the claim level Rendering Provider Secondary Identification loop is sent, NYSDOH expects to receive the State License Number or the NYS Medicaid Provider ID. A State License Number must be preceded by the three-character Profession Code and in most cases, two zeros (exceptions exist for nurses, midwifes, and eye-care providers with prescribing privilege). Refer to the License to Profession Code Mapping document on nyhipaadesk.com for more information about using a license to identify a medical provider. 837 Dental:
When Loop 2310B is sent, NYSDOH expects to receive the Rendering Provider REF segment populated with the State License Number or the NYS Medicaid Provider ID. A State License Number must be preceded by the three-character Profession Code and two zeros. Refer to the License to Profession Code Mapping document on nyhipaadesk.com for more information about using a license to identify a medical provider.

Enter the data in the loop and segments provided, and resubmit.