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.