Edit 02051


Invalid NPI and MMIS Group Provider ID Combination

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

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

Solution:
Check to ensure the submitted group NPI and the submitted Group MMIS Provider ID are correct for the group provider. If the group NPI and MMIS Group Provider ID combination is correct, then the state registration file is incorrect. The provider must 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) REF (Pay-to Provider Secondary Identification) REF02 (Pay-to Provider Additional Identifier)