|
|
 |
Edit 00975
Claim Provider ID not equal Patient Participation File Provider for any of the service period
HIPAA Claim Adjustment Reason Code: B7
Remark Code: N/A
HIPAA Healthcare Claim Status Code: 109
Entity Identifier Code: 1P
Potential Causes:
The Principle Provider File is not showing the recipient as being in the facility.
Solution:
Please verify the Recipient ID and the Billing Provider ID. Correct if necessary. If both are correct, then contact the County Department of Social Services to correct the State Principle Provider File. If not, enter the data in the loop and the segment provided, and resubmit.
| 837 Institutional |
Loop 2010AA, NM1 (Billing Provider Name)
NM101 = 85 (Billing Provider)
And
Loop 2010AA, REF (Billing Provider Secondary Identification)
REF01 = 1D (Qualifier for Medicaid Provider Number)
REF01 = Medicaid Provider Number
And
Loop 2010AA, REF (Billing Provider Secondary Identification)
REF01 = LU (Qualifier for Location Number)
REF01 = Location Number
And
Loop 2010BA, NM1 (Subscriber Name)
NM108 = MI (Identification Code Qualifier)
NM109 = Recipient ID number (Identification Code) |
|
