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Edit 00903
Ordering or Referring NPI, Provider ID or License Number not on Claim
HIPAA Claim Adjustment Reason Code: 16
Remark Code:
N287
HIPAA Healthcare Claim Status Code: N/A
Entity Identifier Code: N/A
Potential Causes:
The procedure or type of service the provider is billing for requires a Referring Provider and it is missing from the claim.
Solution:
Please make corrections in the following locations and resubmit. If entering a license number, formatting requirements apply as described in the FAQ License Number - How to send a License Number as a Provider Identifier?
Note that NYSDOH, as recommended by CMS, will not reject or deny claims for the Referring/Ordering provider not having been identified by NPI. However, NPI is strongly advised and must be sent if available.
| 837 Institutional |
Loop 2310C or 2420C
NM1 (Other Provider Name)
NM108 = XX (Identification Code Qualifier)
NM109 = National Provider Identifier
If the Referring Physician’s NPI is not available do not populate NM108 and NM109. Send:
REF (Other Provider Secondary Identification)
REF01 = 1D or 0B (Reference Identification Qualifier)
REF02 = Provider ID or License Number (Reference Identification)
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| 837 Professional and 837 Dental |
Loop 2310A or 2420F
NM1 (Referring Provider Name)
NM108 = XX (Identification Code Qualifier)
NM109 = National Provider Identifier
If the Referring Physician’s NPI is not available do not populate NM108 and NM109. Send:
REF (Referring Provider Secondary Identification)
REF01 = 1D or 0B (Reference Identification Qualifier)
REF02 = Provider ID or License Number (Reference Identification)
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