Edit 00162

Recipient Ineligible on Service Date

HIPAA Claim Adjustment Reason Code: 27
     Remark Code: N/A
HIPAA Healthcare Claim Status Code: 88
     Entity Identifier Code: QC

Potential Causes:
The patient’s data on the NYS file does not show the person as eligible for Medicaid on the Date of Service being billed. The patient’s County Department of Social Services (DSS) is responsible for updating the State eligibility files.

Solution:
The provider should verify eligibility for the recipient using MEVS. Eligibility can be checked via ePACES, POS machine (VeriFone Omni 3750/Vx570), or the ARU (800-997-1111). If you need assistance using the ARU please contact the eMedNY Call Center at 800-343-900. If patient is not eligible, the provider needs to contact the patient’s County DSS for assistance.