Edit 01239

Supervising Provider Of The Submitted Orderer/Prescriber Was Excluded Prior To Service Date

HIPAA Claim Adjustment Reason Code: 16
            Remark Code: N298
HIPAA Healthcare Claim Status Code: N/A
            Entity Identifier Code: N/A

Potential Causes:
If the Ordering/Prescribing Provider is a Physician’s Assistant (Profession Code 023) or a Nurse Practitioner (Profession Code 028 or 030-045), this means that the Information on file for the Supervising Provider indicates that they are no longer active with NYS Medicaid.

Solution:
The Ordering/Prescribing Provider needs to contact the CSC Provider Enrollment unit (1-800-343- 9000, options 1 and 1) to update their Supervising Physician. If the Orderer/Prescriber is a Physician’s Assistant, they will then be advised to send in the Supervising Physician’s Certification and Enrollment Questionnaire to add their new (current) Supervising Physician to their file. When sending the Questionnaire they must also attach a written request on letterhead to disaffiliate the old (previous) Supervising Physician on their file .

If the Orderer/Prescriber is a Nurse Practitioner, they must complete the Collaborating Physician form and also attach a statement on letterhead advising CSC Provider Enrollment to disaffiliate them from the previously recorded Supervising Provider.

The required forms can be found at eMedNY.org - scroll down to Featured Links, then choose Provider Enrollment Forms and pick the applicable form from the list.