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Edit / Error Knowledge Base > Select Edit Range > 00701 to 00800 >

Edit 00749

Service Authorization Exception Code Misused, Access eMedNY Medicaid Eligibility Verification System EMEVS

HIPAA Claim Adjustment Reason Code: 15
Remark Code: N54
HIPAA Healthcare Claim Status Code: 122
Entity Identifier Code: N/A

Potential Causes:
A Service Authorization Code was entered that is not on the list of acceptable Service Authorization Exception Codes or a Service Authorization Code of 7 was entered on a claim and no exempt Specialty was present on the Provider file.

Solution:
Only use those Service Authorization Exception Codes listed in the 837 Supplemental Companion Guides located on this site (www.nyhipaadesk.com). The use of the Service Authorization Exception Code 7 is limited to those claims where an exempt Specialty is billed and that exempt specialty is on the provider file. (Again, refer to the 837 Supplemental Companion Guides for a list of Specialty Codes.) Enter the data in the loop and the segment provided, and resubmit.

Note: Dental Clinics should not send the Service Authorization Exception Code 7 (REF*4N*7), as their claims will be denied.

837 Institutional and 837 Professional

Loop 2300, REF (Service Authorization Exception Code)
REF01 = 4N (Reference Identification Qualifier)
REF02 = 7 (Reference Identification)

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