Edit 02041


Group MMIS Provider ID Cannot be Derived

HIPAA Claim Adjustment Reason Code: 208
    Remark Code: MA112
HIPAA Healthcare Claim Status Code: 562
    Entity Identifier Code: 1T

Potential Causes:
The Group MMIS Provider ID cannot be derived from the group provider’s NPI. Claim processing requires the Group MMIS Provider ID.

Solution:
The NPI of the Group that was entered on the claim is not on file with NYS Medicaid. Check the NPI used to ensure the correct NPI was entered on the claim.

The claim denial will be on the remittance of the Billing Provider. If the correct NPI was entered contact the NYS Medicaid enrollment unit at 518-402-7032.

837 Professional, 837 Dental

Loop 2010AB NM1 (Pay-to Provider Name) NM109 (Pay-to Provider Primary Identifier)