Edit 02054


Invalid NPI and MMIS Operating Provider ID Combination

HIPAA Claim Adjustment Reason Code: 208
    Remark Code: N262
HIPAA Healthcare Claim Status Code: 562
    Entity Identifier Code: 72

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

Solution:
Check to ensure the submitted NPI and MMIS Provider ID are correct for the Operating Physician. 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.

837 Institutional

Loop 2310B NM1 (Operating Physician Name) NM109 (Operating Physician Primary Identifier) REF (Operating Physician Secondary Identification) REF02 (Operating Physician Additional Identifier) - or - Loop 2420B NM1 (Operating Physician Name) NM109 (Operating Physician Primary Identifier) REF (Operating Physician Secondary Identification) REF02 (Operating Physician Additional Identifier)