Edit 00125

Prov Categ of Svce Not On File

HIPAA Claim Adjustment Reason Code: 16
     Remark Code: N94
HIPAA Healthcare Claim Status Code: 145
     Entity Identifier Code: 1P

Potential Causes:
The Category of Service derived by the system is not on the Provider Master File as a valid Category of Service for the Billing Provider.

Solution:
This edit will be the result of an incorrect Rate Code (if Institutional Rate Based claim) or the entry of an incorrect/invalid HCPCS Procedure Code. Check the Rate Code entered to ensure the correct Rate Code was used. If you are unsure of your Rate Codes contact Provider Services. If submitting a procedure-based claim, check the Procedure Code to ensure the correct procedure was entered for the service performed. Be sure to use only those procedures found in the Medicaid fee schedule. There are numerous fee schedules, please be sure you use the correct schedule for your type of billing.

If you need a Medicaid fee schedule contact Provider Services.