| 00001 |
RECIPIENT SEX INVALID, MUST INDICATE M OR F |
Resubmit claim with a valid value of either M or F. |
| 00036 |
AMOUNT CHARGED IS MISSING OR INVALID |
Amount charged is a required field. The provider must decide what charge amount to submit on the claim. The charge field does not affect Health Home claim payment. |
| 00129 |
RATE CODE NOT ON RATE FILE |
The Health Home rate code is not on your rate file for the date of service on the claim. If you think you should have a Health Home rate code on your rate file for the date of service on the claim, contact the HH Provider Line. |
| 00142 |
RECIPIENT BIRTH DATE NOT EQUAL FILE |
Recipient's birth date on the claim must match the recipient's birth date on their official Medicaid File. |
| 00144 |
RECIPIENT SEX NOT EQUAL FILE |
Recipient's sex on the claim must match the recipient's sex on their official Medicaid File. |
| 00162 |
RECIPIENT INELIGIBLE ON SERVICE DATE |
Claim cannot be paid. Recipient was not Medicaid eligible on the claim's service date. |
| 00547 |
RECIPIENT INELIGIBLE (COVERAGE CODE IS EQUAL TO 07) |
Claim cannot be paid. Recipient had Emergency Medicaid coverage only on the claim's service date. |
| 00689 |
RECIPIENT NO LONGER PREPAID CAPITATION PLAN ENROLLEE |
Patient not enrolled in the billing provider's managed care plan on the date of service. |
| 00692 |
DATE OF SERVICE MUST BE 1ST OF MONTH |
The date of service on a Health Home claim must be the first of the month. If Health Home services were provided on 5/12/13, the date of service on the claim must be 5/1/13. |
| 00705 |
DUPLICATE CLAIM IN HISTORY |
This claim has already been submitted to eMedNY. |
| 00715 |
PROCEDURE CONFLICTS WITH PRIOR SERVICE |
If edit key is 9576 or 9641, please see table below for additional information. If the edit key is neither 9576 nor 9641, another provider has already submitted a Health Home claim for this member on this date of service. For additional information, please contact the HH provider line. |
| 00727 |
NEAR DUPLICATE CLAIM IN HISTORY |
Call CSC |
| 01044 |
DATES OF SERVICE CANNOT SPAN ACROSS MONTHS |
Each claim can only cover services provided in one calendar month. |
| 01314 |
RECIPIENT INELIGIBLE - SERVICE NOT COVERED BY FAMILY PLANNING |
Claim cannot be paid. Recipient had Family Planning Coverage only on the claim's service date. |
| 02020 |
MISSING BILLING NPI |
Resubmit claim with a valid NPI. |
| 02068 |
PROVIDER RATE FOUND WITHOUT MATCHING ZIP/LOCATOR CODE |
Resubmit the claim with the zip code that is associated with the location of service where the Health Home rate codes are loaded. If you cannot determine which zip code should be listed on your claim, contact the HH Provider Line. |
| 02212 |
HEALTH HOME RATE CODE - CLIENT DOES NOT HAVE A VALID HEALTH HOME PAYMENT WEIGHT ON FILE |
The member was not pre-identified as Health Home eligible. Make sure that the member's Health Home has submitted the member to the Tracking System. DOH will periodically review the tracking system and load the statewide average acuity score for members in the tracking system that do not have an acuity score. The claim will pend for 60 days. The system will check to see if the member's acuity score has been loaded once a week. Once the acuity score has been loaded, the claim will pay. If the member's acuity score is not loaded within the 60 window, then the claim will deny. |
