Edit 01123

Medical Assistance Coverage “I” – Recipient Ineligible For This Service

HIPAA Claim Adjustment Reason Code: 16
    Remark Code: N30
HIPAA Healthcare Claim Status Code: 109
    Entity Identifier Code: QC

Potential Causes:
The eligibility of the Patient is for Pre-natal Care Services only and the claim is not for Pre-natal care services.

Solution:
Check the Rate Code to ensure the correct Rate Code was used. Check the eligibility of the Patient using MEVS. If the eligibility of the patient is incorrect contact the Department of Social Services. Enter the data in the loops and segments provided and resubmit.