Edit 01164

Recipient not Qualified Medicare Beneficiary (QMB), Service not Reimbursable for Category of Service (COS)

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

Potential Causes:
The recipient is not on file as a Qualified Medicare Beneficiary (QMB) and the service billed requires that the recipient be designated as a QMB recipient.

Solution:
Contact the Department of Social Services regarding the QMB status of the recipient.