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Edit 00538
Ordering/Referring Provider Profession Code Invalid
HIPAA Claim Adjustment Reason Code:
184
Remark Code: N/A
HIPAA Healthcare Claim Status Code: 109
Entity Identifier Code: DK
Potential Causes:
The license type entered is not a valid license type.
Solution:
The 2-digit license type entry precedes the license number. Check the license type used to ensure the correct license type is entered. Check the qualifier to ensure the correct qualifier is used. (The qualifier 0B should be used when entering a license type and license number). Enter the data in the loop and the segment provided, and resubmit.
Note:
For 837P, NYSDOH processes Referring Provider information as follows: Two iterations of Loop 2310A may be required in certain cases. The first iteration processes Referring Provider information. The second iteration processes Other Referring Provider information if applicable in certain cases.
| 837 Professional |
First Iteration:
Loop 2310A, NM1 (Referring Provider Name)
NM101 = DN (to indicate Referring Provider)
NM108 = 24 (Employer’s Identification Number)
Or
NM108 = 34 (Social Security Number)
NM109 = Employer’s Identification Number or Social Security Number
And
Loop 2310A, REF (Referring Provider Secondary Identifier)
REF01 = 1D (to indicate Medicaid Provider ID)
Or
REF01 = 0B (to indicate License Type followed by License Number)
REF02 = Referring Provider Secondary Identifier
Second Iteration (if applicable):
Loop 2310A, NM1 (Referring Provider Name)
NM101 = P3 (to indicate Primary Care Provider)
NM108 = 24 (Employer’s Identification Number)
Or
NM108 = 34 (Social Security Number)
NM109 = Employer’s Identification Number or Social Security Number
And
Loop 2310A, REF (Referring Provider Secondary Identifier)
REF01 = 1D (to indicate Medicaid Provider ID)
Or
REF01 = 0B (to indicate License Type followed by License Number)
REF02 = Referring Provider Secondary Identifier
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