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Edit 00941
Service Provider Excluded Prior to Serv/Order Date
HIPAA Claim Adjustment Reason Code: B7
Remark Code: N/A
HIPAA Healthcare Claim Status Code: 91
Entity Identifier Code: SJ
Potential Causes:
The Service Provider has been excluded from participating in Medicaid. The New York State Department of Health maintains a list of providers that they have determined cannot participate in the Medicaid Program.
Solution:
Verify that the Provider ID or License Number entered, as the Service Provider, is the correct number. If the number was entered correctly, then the claim cannot be submitted in that the Service Provider is excluded from participating in the Medicaid Program. 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 and 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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