Edit 02068


Provider Rate Found Without Matching Zip Code or Locator Code

HIPAA Claim Adjustment Reason Code: 208
    Remark Code: N79
HIPAA Healthcare Claim Status Code: 109
    Entity Identifier Code: 1T

Potential Causes:
The submitted rate code is on the provider file but the Locator Code could not be derived from the zip code. If the rate code is on file but the submitted zip+4 does not match any on file Locator Code, the lowest amount available will be paid and edit 02068 will be set. This is a “Pay” edit which means the claim will be paid but the edit will be set to flag the claim as having an issue.

Solution:
Because the eMedNY claims adjudication process derives the Locator Code from the “Zip+4” zip code it is essential that the full 9-digit zip code be used. Contact the CSC Call Center help line at 800-343-9000 if further assistance is required.

837 Institutional

Loop 2010AA N4 (Billing Provider City/State/ZIP Code) N403 (Billing Provider Postal Zone or ZIP Code)