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Edit 00263
Servicing Provider ID or License NO and Profession Code Are Required
HIPAA Claim Adjustment Reason Code: 16
Remark Code: N31
HIPAA Healthcare Claim Status Code: 143
Entity Identifier Code: SJ
Potential Causes:
Both a Service License Number and a License Type are required on the Claim. You are not allowed to use an MMIS Provider number as the service provider for this type of claim.
Solution:
Ensure that the entry is the License number of the servicing provider preceded by the two-digit license type. Enter the data in the loop and the segment provided, and resubmit.
NOTE: Qualifier 1D in REF01 MUST NOT be used for this claim type.
| 837 Institutional AND 837 ProfessionaL |
INSTITUTIONAL:
Loop 2310A, REF (Attending Physician Secondary Identification)
REF01 = 0B (Reference Identification Qualifier)
REF02 = License Number Preceded by License Type (Reference Identification)
PROFESSIONAL:
Loop 2310B, REF (Rendering Provider Secondary Identification)
REF01 = 0B (Reference Identification Qualifier)
REF02 = License Number Preceded by License Type (Reference Identification) |
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