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Edit 01009
Referral Data Inconsistent
HIPAA Claim Adjustment Reason Code: 16
Remark Code: N287
HIPAA Healthcare Claim Status Code: 153
Entity Identifier Code: DN
Potential Causes:
A 2 digit value was entered as the License Type but the License Number entry was not made.
Solution:
Please verify the State License Number and License Type. The License Number must be entered preceded by the License Type. Resubmit using the loop and segment provided.
| 837 Institutional |
Loop 2310C NM1 (Other Provider Name)
NM101 = 73 (Other Physician)
NM108 = 24 (Employer’s Identification Number)
Or
NM108 = 34 (Social Security Number)
NM109 = (Employer’s Identification Number or Social Security Number)
And
Loop 2310C, REF (Other Provider Secondary Identification)
REF01 = 0B (to indicate State License Number preceded by License type)
Or
REF01 = 1D (to indicate Medicaid Provider ID)
REF02 = Other Provider Secondary Identifier |
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)
NM108 = 24 (Employer’s Identification Number)
NM101 = DN (to indicate Referring Provider)
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)
Or
REF01 = 1D (to indicate Medicaid Provider ID)
REF02 = Referring Provider Secondary Identifier
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
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 |
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