www.eMedNY.org

Home | Glossary | Site Map

Search

NYHIPAADESK

	eMedNY Overview
	NPI
	Archived Items
	Edit/Error Knowledgebase
	Crosswalks
	eMedNY Companion Guides and Sample Files
	FAQ's
	NEWS DOH CSC / eMedNY
	Provider Training Material
	Registration Information Trading Partner Resources
	Useful External Links
	Vendor Information
	Issues Form
	NYS Medicaid eMedNY Compliant Transactions
	ePACES General Information and Enrollment
	NYS Medicaid: POS Device
	eMedNY Quick Reference
	Other New York State Department of Health HIPAA Related Websites

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

Edit 00766

Duplicate Dental / Clinic Claim

HIPAA Claim Adjustment Reason Code: 16
Remark Code: N111
Healthcare Claim Status Code: 54
Entity Identifier Code: N/A

Potential Causes:
This edit will fail when the following fields are equal between an in-process Dental claim and a previously paid Dental or Dental Clinic claim.

Provider Number
Client Identification Number
Service Date
Procedure Code

Solution:
Verify the accuracy of the data items listed below. If correct, the claim is not payable. Do not resubmit.

837 Dental

Loop 2010AA, NM1 (Billing Provider Name)
NM108 = XX (Qualifier for NPI)
NM109 = NPI

Loop 2010BA, NM1 (Subscriber Name)
NM108 = MI (Identification Code Qualifier)
NM109 = Recipient ID Number (Subscriber Primary Identifier)

Loop 2300, SV3 (Dental Service)
SV301-1 = AD (Qualifier for American Dental Association Codes)
SV301-2 = Procedure Code

Loop 2400, DTP (Date – Service)
DTP01 = 472 (Qualifier for Service Date)
DTP02 = D8 (Date Expressed in Format CCYYMMDD)
DTP03 = Service Date

	New York State Department of Health	Home \| Glossary \| Site Map
		webmaster@emedny.org \| Privacy Policy