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Edit 00915
Invalid Service Provider License Type on Claim
HIPAA Claim Adjustment Reason Code: 16
Remark Code: N31
HIPAA Healthcare Claim Status Code: 143
Entity Identifier Code: SJ
Potential Causes:
The Service Provider License Type was reported with an Alpha character, and all License type
codes are two digit numeric entries or no license type was entered and the first 2 characters of
the License number were used as the License Type.
Solution:
Check to ensure that the License Number that is being entered is preceded by the two-digit,
numeric, License Type. If entering a Provider ID number then no License Type is required. Check
the qualifier to ensure 1D is used for the Provider ID entry. Enter the data in the loop and the
segment provided, and resubmit.
| 837 Institutional |
Loop 2310A, REF (Attending Physician Secondary Identification)
REF01 = 1D (Reference Identification Qualifier)
REF02 = Provider ID (Reference Identification)
Or
REF01 = 0B (Reference Identification Qualifier)
REF02 = License Number Preceded by License Type (Reference Identification) |
| 837 Professional |
Loop 2310B, REF (Rendering Provider Secondary Identification)
REF01 = 1D (Reference Identification Qualifier)
REF02 = Provider ID (Reference Identification)
Or
REF01 = 0B (Reference Identification Qualifier)
REF02 = License Number Preceded by License Type (Reference Identification) |
| 837 Dental |
Loop 2310B, REF (Rendering Provider Secondary Identification)
REF01 = 1D (Reference Identification Qualifier)
REF02 = Provider ID (Reference Identification)
Or
REF01 = 0B (Reference Identification Qualifier)
REF02 = License Number Preceded by License Type (Reference Identification) |
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