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Edit 00250
Recipient ID Number Unequal to Prior Approval File
HIPAA Claim Adjustment Reason Code: 16
Remark Code: N54
HIPAA Healthcare Claim Status Code: 91
Entity Identifier Code: QC
Potential Causes:
The Recipient ID Number on the Claim is not the same as the Recipient Number on the Prior Approval number submitted on the claim.
Solution:
Check the Prior Approval Number entered on the claim, if correct then check to ensure the correct recipient ID number is entered on the claim. Enter the data in the loop and the segment provided, and resubmit.
| 837 Institutional, 837 Professional and 837 Dental RECIPIENT ID NUMBER |
Loop 2010BA, NM1 (Subscriber Name)
NM108 = MI (Identification Code Qualifier)
NM109 = Recipient ID number (Identification Code) |
Prior Approval:
| 837 Institutional |
Loop 2300, REF (Prior Authorization or Referral Number)
REF01 = G1 (Prior Authorization Number)
REF02 = Prior Authorization Number |
| 837 Professional |
Loop 2300, REF (Prior Authorization or Referral Number)
REF01 = G1 (Prior Authorization Number)
REF02 = Prior Authorization Number
Or
Loop 2400, REF (Prior Authorization or Referral Number)
REF01 = G1 (Prior Authorization Number)
REF02 = Prior Authorization Number
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| 837 Dental |
Loop 2300: REF (Prior Authorization or Referral Number)
REF01 = G1 (Reference Identification Qualifier)
REF02 = Prior Approval Number (Reference Identification)
Or
Loop 2400, REF (Prior Authorization or Referral Number)
REF01 = G1 (Prior Authorization Number)
REF02 = Prior Authorization Number
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