Edit 00286

Child Care Recipient Bill Agency

HIPAA Claim Adjustment Reason Code: 109
    Remark Code: M97
HIPAA Healthcare Claim Status Code: 9
    Entity Identifier Code: N/A

Potential Causes:
The Recipient’s state file shows that the recipient is in a Child Care agency and the agency is responsible for the claim. State policy requires that Child Care Agencies are responsible for certain types of services. The service billed is one of those services and therefore must be billed directly to the Child Care Agency.

Solution:
Check the Recipient ID number to ensure the correct number was entered. Contact the Local Department of Social Services to determine what Child Care Agency the recipient is in and bill that Agency. For the service being billed to NYS Medicaid, correct the data in the loop and the segment provided, and resubmit.