Edit 02052


Invalid NPI and MMIS Referring Provider ID Combination

HIPAA Claim Adjustment Reason Code: 208
    Remark Code: N286
HIPAA Healthcare Claim Status Code: 562
    Entity Identifier Code: DN

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

Solution:
Check to ensure the submitted NPI and MMIS ID are correct for the referring provider. If the NPI and MMIS ID are 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

Loop 2310C NM1 (Other Provider Name) NM109 (Other Provider Primary Identifier) REF (Other Provider Secondary Identification) REF02 (Other Provider Additional Identifier) - or - Loop 2420C NM1 (Other Provider Name) NM109 (Other Provider Primary Identifier) REF (Other Provider Secondary Identification) REF02 (Other Provider Additional Identifier)

837 Professional

Loop 2310A NM1 (Referring Provider Name) NM109 (Referring Provider Primary Identifier) REF (Referring Provider Secondary Identification) REF02 (Referring Provider Additional Identifier) - or - Loop 2420F NM1 (Referring Provider Name) NM109 (Referring Provider Primary Identifier) REF (Referring Provider Secondary Identification) REF02 (Referring Provider Additional Identifier)

837 Dental

Loop 2310A NM1 (Referring Provider Name) NM109 (Referring Provider Primary Identifier) REF (Referring Provider Secondary Identification) REF02 (Referring Provider Additional Identifier)