Edit 01243

Prescribing Provider not in Active Status on Date of Service

HIPAA Claim Adjustment Reason Code: 16
            Remark Code: N31
HIPAA Healthcare Claim Status Code: 91
            Entity Identifier Code: DK

Potential Causes:
The Provider License Number entered on the claim as the Prescribing Provider is not in an active status with NYS Medicaid.

Solution:
Check to ensure that the license number entered is correct. If the license number entered is correct, contact the CSC Call Center for further assistance. (NOTE: There are formatting requirements for using a license number. Refer to the License Type to Profession Code Mapping under “Crosswalks” at nyhipaadesk.com.) Please use the loop and segment below and resubmit.