Edit 00267

Vehicle License Plate / Driver’s License Required

HIPAA Claim Adjustment Reason Code: 16
    Remark Code: N59
HIPAA Healthcare Claim Status Code: 560
    Entity Identifier Code: 30

Potential Causes:
An Ambulette claim requires Vehicle License Plate Number and the Driver’s License Number. Either the Vehicle License Plate Number is equal to spaces in the Service Provider ID field or the Qualifier is incorrect, or the Driver’s License Number is equal to spaces in the Other Referring Provider License Number field and in the Other Referring Profession Code field or the Qualifier is incorrect.

Solution:
Ambulette claims must be submitted with the Vehicle License Plate Number and the operator’s Driver’s License Number. The alphanumeric Vehicle License Plate Number must be entered in the Rendering Provider Secondary Identification segment in Loop 2310B on the claim. (Note: qualifier 1D must be entered in REF01 as well.)

All nine (9) numeric digits of the Vehicle Operator’s Driver’s License Number must be entered in the Referring Provider Secondary Identification segment in Loop 2310A. (Note: qualifier 0B must be entered in REF01 as well.) It is important to note that Provider’s must enter the Driver’s License Number exactly as it appears on the Driver’s License Card. The Provider should no longer enter the last digit of the license in the first byte of the field. Additionally, spaces must no longer be imbedded within the Driver’s License entry.

Out-of-State Providers: Using the above instructions, for license number, enter only the first nine (9) digits. If a Driver’s License Number is less than nine (9) digits, the provider must enter the number as right justified, zero-filled.

For further instructions please review the 837P Non-Emergency Companion Guide http://www.emedny.org/HIPAA/emedny_Transactions/transactions.html located on our site nyhipaadesk.com.

Resubmit your claim using the information provided in the loops and segment below.