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Invalid NPI and MMIS Billing Provider ID Combination

HIPAA Claim Adjustment Reason Code: 208
    Remark Code: N257
HIPAA Healthcare Claim Status Code: 562
    Entity Identifier Code: 85

Potential Causes:
The submitted Billing Provider NPI is not on the New York State NPI registration file as belonging to the same provider as the submitted Billing Provider’s MMIS Provider ID.

Solution:
Check to ensure the submitted NPI and MMIS Provider ID are correct for the billing provider. If the NPI and MMIS ID combination is correct, then the state registration file is incorrect. The provider must contact the NYS Medicaid Enrollment Unit at 800-342-3005 (for rate-based providers) or 518-402-7032 (for fee for service providers).

837 Institutional, 837 Professional, 837 Dental

Loop 2010AA NM1 (Billing Provider Name) NM109 (Billing Provider Primary Identifier) REF (Billing Provider Secondary Identification) REF02 (Billing Provider Additional Identifier)