Edit 00078

Referring Provider ID Number Invalid

HIPAA Claim Adjustment Reason Code: 183
            Remark Code: N287
HIPAA Healthcare Claim Status Code: 153
            Entity Identifier Code: DN

Potential Causes:
The MMIS ID number entered as the Referring Provider Number is invalid. The problem may be that the number submitted is a License Number but the Profession Code was left off the entry and the qualifier was entered as 1D ( Provider ID number) rather than 0B (License number).

Solution:
The entry of an MMIS Provider ID requires the use of qualifier 1D followed by the entry of an 8 digit MMIS Provider ID number. The entry of a License Number requires qualifier 0B and the three character Profession Code and two zeros to precede the License Number. Please check your information using the loops and segments provided below and resubmit.

License Number Note:

837 Institutional (Claim Level only):
When Loop 2310C is sent NYSDOH expects to receive the Referring Provider Secondary Identification 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 PROVIDER LICENSE TYPE TO PROFESSION CODE MAPPING document on nyhipaadesk.com for more information about using a license to identify a medical provider.
837 Dental and Professional Claim Level:
When Loop 2310A is sent, NYSDOH expects to receive the Referring Provider Secondary Identification 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 PROVIDER LICENSE TYPE TO PROFESSION CODE MAPPING document on nyhipaadesk.com for more information about using a license to identify a medical provider.
837 Professional Line Level:
When the line-level Referring Physician Name 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 PROVIDER LICENSE TYPE TO PROFESSION CODE MAPPING document on nyhipaadesk.com for more information about using a license to identify a medical provider. .