Edit 01497

Family Health Plus Claim Not Covered

HIPAA Claim Adjustment Reason Code: 31
            Remark Code: N216
HIPAA Healthcare Claim Status Code: 585
            Entity Identifier Code: N/A

Potential Causes:
The Recipient ID is on file as covered by Family Health Plus. Family Health Plus is not NYS Medicaid.

Solution:
Check the Recipient ID to ensure that the correct ID number was used. Using the MEVS system, check the eligibility of the patient. The patient must be NYS Medicaid Eligible to bill. If the patient is Family Health Plus, contact the Plan that the patient belongs to for payment. Enter the data in the loop and the segment provided, and resubmit.