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Edit 00140
Recipient ID Number Not on File
HIPAA Claim Adjustment Reason Code: 31
Remark Code: N/A
HIPAA Healthcare Claim Status Code: 109
Entity Identifier Code: QC
Potential Causes:
The Recipient ID may be either new or incorrect.
Solution:
Verify that the Recipient ID is correct using the Medicaid Eligibility Verification System (MEVS). Eligibility can be checked via ePACES, POS machine (VeriFone Omni 3750/Vx570), or the ARU (800-997-1111). Ensure the number entered is entered as 2 letters, 5 numbers and a letter (AA11111Z).
If the number is not in the MEVS system, the Medicaid client may have been issued a temporary ID card and the information may not be on file. If the client presented a temporary ID card, check with the local County DSS to ensure the information is correct. When the information is on file in the MEVS system, resubmit the claim.
| 837 Institutional 837 Professional and 837 Dental |
Loop 2010BA, NM1 (Subscriber Name)
NM108 = MI (Identification Code Qualifier)
NM109 = Recipient ID number (Identification Code)
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