Edit 00239

No Fault or Workmans Comp Indicated/Not Covered by Medicaid

HIPAA Claim Adjustment Reason Code: 109
     Remark Code: N/A
HIPAA Healthcare Claim Status Code: 116
     Entity Identifier Code: N/A

Potential Causes:
The Accident Code reported on the claim is indicating that Workmen’s Comp or No Fault is involved in the claim. If Workmen’s Comp or No Fault is involved in a claim, Medicaid will not pay the claim.

Solution:
Check to ensure the correct Accident Code was entered. If it was, the claim is not a valid Medicaid claim and cannot be billed. Additionally, please refer to the Section 9. Occurrence Codes in the 837 Institutional Supplemental Companion Guide or Section 14. Related Causes Information in the 837 Dental Supplemental Companion Guide located on this website (www.nyhipaadesk.com). Enter the data in the loop and the segment provided, and resubmit.