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Edit 01236
Order/Referring License not on NYS License File
HIPAA Claim Adjustment Reason Code: 16
Remark Code: N31
HIPAA Healthcare Claim Status Code: 143
Entity Identifier Code: DN
Potential Causes:
The license number entered on the claim, as the referring provider is not on file. If a provider number was entered on the claim, then the 1D qualifier was not used.
Solution:
Please make corrections in the following loop and segment and re-submit. If entering a license number, the license type must precede the license number.
| 837 Institutional |
Loop 2310C, REF (Other Provider Secondary Identification)
REF01 = 1D or 0B (Reference Identification Qualifier)
REF02 = Provider ID or License Number (Reference Identification) |
| 837 Professional and 837 Dental |
Loop 2310A, REF (Referring Provider Secondary Identification)
REF01 = 1D or 0B (Reference Identification Qualifier)
REF02 = Provider ID or License Number (Reference Identification) |
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