|
|
 |
Edit 00858
Ordering/Referring Provider Type Invalid for Service
HIPAA Claim Adjustment Reason Code:
183
Remark Code: N/A
HIPAA Healthcare Claim Status Code: 109
Entity Identifier Code: DK
Potential Causes:
The license type entered for the Referring Provider cannot be used for Transportation claims. Only certain provider types can refer for Transportation services.
Solution:
Check the License Type used to ensure the correct entry was made. Verify that the entry made is either a License Number or Provider ID Number. If a Provider number was entered as the Referring Provider, check to ensure the correct qualifier was used to indicate a Provider ID number. If additional information is needed as to what License Types are valid for Transportation Services, contact Provider Services. Enter the data in the loop and the segments 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.
For Ordered Services (DME), utilize Loop 2420E at the line level.
| 837 Professional |
First Iteration:
Loop 2310A, NM1 (Referring Provider Name)
NM101 = DN (to indicate Referring Provider)
NM108 = 24 (Employer’s Identification Number)
Or
NM109 = Employer’s Identification Number or Social Security Number
NM108 = 34 (Social Security Number)
And
Loop 2310A, REF (Referring Provider Secondary Identifier)
REF01 = 0B (to indicate State License Number preceded by License type)
= 1D (to indicate Medicaid Provider ID)
REF02 = Referring Provider Secondary Identifier
Or
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 = 0B (to indicate State License Number preceded by License type)
= 1D (to indicate Medicaid Provider ID)
REF02 = Referring Provider Secondary Identifier
Or
For Ordering Provider (DME):
Loop 2420E, NM1 (Ordering Provider Name)
NM101 = DK (to indicate Ordering Physician)
NM108 = 24 (Employer’s Identification Number)
Or
NM108 = 34 (Social Security Number)
NM109 = Employer’s Identification Number or Social Security Number
And
Loop 2420E, REF (Ordering Provider Secondary Identification)
REF01 = 0B (to indicate State License Number preceded by License type)
= 1D (to indicate Medicaid Provider ID)
REF02 = Ordering Provider Secondary Identifier |
|
