|
Edit 01357
Provider ID and Service ID Identical
HIPAA Claim Adjustment Reason Code: 16
Remark Code: N291
HIPAA Healthcare Claim Status Code: 153
Entity Identifier Code: SJ
Potential Causes:
This edit will hit if the Billing Provider and Attending Physician on the 837 Institutional are identified with the same MMIS ID/NPI. The Billing and Service Provider should not be the same. This edit can affect only Institutional claims.
Solution:
Remove or correct the entry for the Attending Physician. The Attending Physician cannot be sent with the same provider identifier as the billing provider. Check the following location:
| 837 Institutional |
2010AA
NM1 (Billing Provider Name
NM109 (Billing Provider Primary Identifier)
- and/or -
REF (Billing Provider Secondary Identification)
REF02 (Billing Provider Additional Identifier)
2310A
NM1 (Attending Physician Name
NM109 (Attending Physician Primary Identifier)
- and/or -
REF (Attending Physician Secondary Identification)
REF02 (Attending Physician Secondary Identifier)
2420A
REF (Attending Physician Secondary Identification)
REF02 (Attending Physician Secondary Identifier)
- and/or -
REF (Attending Physician Secondary Identification)
REF02 (Attending Physician Secondary Identifier)
|
|
