Edit 01136

Rate Code Invalid For Clinic

HIPAA Claim Adjustment Reason Code: 16
    Remark Code: M49
HIPAA Healthcare Claim Status Code: 463
    Entity Identifier Code: N/A

Potential Causes:
The rate code entered on the claim is not billable by a clinic provider. Rate codes are assigned for provider use by NYSDOH upon enrollment in NYS Medicaid.

Solution:
Refer to the documentation received from NYSDOH upon enrollment in NYS Medicaid. Change the rate code entered on the claim to one assigned to the provider that is correct for the service billed. If further assistance is required call the CSC Call Center at 1-800-343-9000.