Revised edits - s and s Definition 00016 BILLING DATE 16 110 MA52 MA31 00047 00062 00078 00162 00166 00175 EMERGENCY CODE MUST INDICATE Y OR N SERVICE PROVIDER ID NUMBER REFERRING PROVIDER ID NUMBER RECIPIENT INELIGIBLE ON SERVICE DATE PROVIDER INELIGIBLE SERVICE ON DATE PERFORMED SERVICE PROVIDER ID NUMBER NOT ON NYS MASTER FILE M58 MA130 16 38 N291 16 183 N287 30 27 B7 38 N191 00180 UNITS GREATER THAN MAXIMUM 57 151 00223 00227 PROCEDURE CODE INCONSISTENT WITH FAMILY PLANNING CODE PRIMARY DIAGNOSIS INDICATES ABORTION/ABORT CODE 57 96 00228 00526 00528 SECONDARY DIAGNOSIS INDICATES ABORTION/ABORTION CODE PRESCRIPTION / ORDER NUMBER IS MISSING MISSING OR QUANTITY DISPENSED B17 16 00530 NEW / REFILL NUMBER 00531 00532 00538 AUTHORIZED REFILLS NUMBER DISPENSE AS WRITTEN CODE PROFESSION CODE B17 16 52 184 NYS Medicaid Fiscal Agent 1
Revised edits - s and s Definition 00539 REFILL EXCEEDS MAXIMUM NUMBER AUTHORIZED 57 151 00550 PLAN LIMITATIONS EXCEEDED 00556 00568 00598 REFILL NUMBER EXCEEDS MAXIMUM PRESCRIBING PROVIDER PROFESSION CODE FOR ISSUING PRESCRIPTION CATEGORY OF SERVICE FOR NDC CODE 52 16 00663 ADMIT NUMBER MISSING M58 N221 00672 00703 00710 FAMILY PLANNING INDICATOR FOR BILLING PROVIDER INAPROPRIATE SECOND SERVICE - SAME DAY PROCEDURE/FORMULARY CODE EXCEEDS SERVICE LIMITS 57 151 M63 M86 57 150 00712 PROC EXCEEDS SERVICE LIMITS 57 150 00736 DIAGNOSIS CODE BLANK A FULL ICD-9 CM CODE REQUIRED 47 16 MA63 00737 00738 00743 ICD-9-CM DIAGNOSIS CODE ON PHYSICIAN CLAIM NOT ON FILE ICD-9-CM DIAGNOSIS CODE ON PHYSICIAN CLAIM NOT ON FILE DOS FOR WEEKLY RATE NOT ON A SUNDAY MA06 M52 00753 ONLY UPSTATE CONTRACTOR ALLOWED TO BILL FOR SERVICE 00803 PATIENT BORN IN HOSPITAL/YEAR OF BIRTH DIFFERS FROM ADMIT YEAR MA38 N340 00858 TYPE FOR SERVICE NYS Medicaid Fiscal Agent 2
Revised edits - s and s Definition 00897 00898 00899 00903 PRESCRIBING PROVIDER ID NOT ON MMIS PROVIDER FILE/PRESCRIBER TYPE BLANK PRESCRIBING PROVIDER CATEGORY OF SERVICE FOR PHARMACY CATEGORY OF SVC INVALD FOR DME ORDERING OR REFERRING PROVIDER ID OR LICENSE NUMBER NOT ON CLAIM N287 00936 CLINIC SPECIALTY CODE NOT ON NEW YORK STATE MASTER FILE 00939 00941 00942 00944 01008 EXCLUDED PRIOR TO SERVICE/ORDER DATE SERVICE PROVIDER EXCLUDED PRIOR TO SERV/ORDER DATE DECEASED ON SERVICE/ORDER DATE SERVICE PROVIDER DECEASED ON SERVICE/ORDER DATE REFERRING PROVIDER PROFESSION CODE 01009 REFERRAL DATA INCONSISTENT N287 01034 01077 01098 01127 SPECIALTY CODE FOR LONG TERM HHC CATEGORY OF SERVICE DOES NOT ALLOW EMERGENCY RECIPIENT LESS THAN 21/PRESCRIBER NOT PHC NURSE PRACTITIONER/MIDWIFE NOT QUALIFIED TO PRESCRIBE LEGEND DRUGS NYS Medicaid Fiscal Agent 3
Revised edits - s and s Definition 01129 PART A DEDUCTIBLE PREVIOUSLY PAID FOR THIS SPELL OF ILLNESS N17 N182 01158 ENHANCED FEE PROCEDURE CODE USED FOR NON-QUALIFIED RECIPIENT OR PROVIDER 01165 01166 01167 FOR SERVICE - RECIPIENT NOT QUALIFIED MEDICARE BENEFICIARY - MEDICARE APPROVED AMOUNT NOT GREATER THAN ZERO 52 177 52 22 01183 REFERRAL FOR SERVICE 01209 01220 DESIGNATED MENTAL ILLNESS DIAGNOSIS REQUIRED DAY TREATMENT RATE FOR PRINCIPLE PROVIDER CODE 47 12 B6 8 01221 01238 REFERRING ID BLANK - OMH REHABILITATION SERVICE LICENSE NOT ON NYS LICENSE FILE M33 N287 N291 01300 MANAGE CARE COORDINATION PROGRAM INPATIENT SERVICE NOT PROVIDED/ORDERED/REFERRED BY PRIMARY PROVIDER 01304 01340 PROVIDER NOT ALLOWED TO BILL FOR PORTABLE XRAY SERVICES CLAIM PROVIDER NOT EQUAL RESTRICTION RECIPIENT FILE PROVIDER 52 170 NYS Medicaid Fiscal Agent 4
Revised edits - s and s Definition 01342 P.T.CLINIC RATE BILLED/PROVIDER P.T. CLINIC NUMBER MISSING N259 01357 PROVIDER ID AND SERVICE ID IDENTICAL M57 N291 01496 NO COVERAGE: PENDING FAMILY HEALTH PLUS 16 24 MA85 N30 01498 OPTOMETRIST INDICATED NOT QUALIFIED TO PRESCRIBE 52 184 01499 RECIPIENT INELIGIBLE, EXCESS INCOME/SPENDDOWN 30 178 01612 MISSING OR ELIGIBILITY OVERRIDE CODE 30 16 N35 01629 PIN 30 16 N257 01640 DRUG-PREGNANCY INFERRED PRECAUTION 30 153 01700 MAJOR PROGRAM - SERVICE CONFLICT 30 177 N130 NYS Medicaid Fiscal Agent 5