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Edit 01183
Referral Invalid for Service
HIPAA Claim Adjustment Reason Code: 183
Remark Code: N/A
HIPAA Healthcare Claim Status Code: 109
Entity Identifier Code: DN
Potential Causes:
The Provider ID number or the License Number entered as the Referring Provider is not a valid number for referral.
Solution:
Check the number entered to ensure that the correct number was entered. If a Provider ID number was entered check to ensure that the qualifier 1D was used. If entering a License Number, the qualifier 0B should be used with the License Type preceding the License Number. Enter the data in the loop and the segments provided, and resubmit.
| 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
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Note: 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)
NM101 = DN (to indicate Referring 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
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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