Edit 00693

Recipient Not On Prepaid Capitation Plan (PCP)

HIPAA Claim Adjustment Reason Code: 16
    Remark Code: N52
HIPAA Healthcare Claim Status Code: 97
    Entity Identifier Code: QK

Potential Causes:
The Recipient ID is not on file as being in the PCP file.

Solution:
Verify the Recipient ID entered is the correct Recipient ID. If the Recipient ID number entered is correct, contact the County Department of Social Services. Otherwise, enter the data in the loop and the segment provided, and resubmit.