NYS Department of Health Revised eMedNY edits - Reason Codes and Remark Codes
eMedNY System Edit
Edit Definition
Old Reason Code
New Reason Code
Old Remark Code
New Remark Code
16
110
MA52
MA31
BILLING DATE INVALID 00016 EMERGENCY CODE INVALID MUST INDICATE Y OR N 00047
M58
MA130
SERVICE PROVIDER ID NUMBER INVALID 00062
16
38
M68
N291
16
183
M68
N287
30
27
52
B7
B7 57
38 151
M68
N191
57
96
47
D21
47
D21
B17
16
57 57
16 16
57
16
REFERRING PROVIDER ID NUMBER INVALID 00078 00162 00166
00175 00180
00223 00227
00228 00526 00528 00530 00531
RECIPIENT INELIGIBLE ON SERVICE DATE PROVIDER INELIGIBLE SERVICE ON DATE PERFORMED SERVICE PROVIDER ID NUMBER NOT ON NYS MASTER FILE UNITS GREATER THAN MAXIMUM PROCEDURE CODE INCONSISTENT WITH FAMILY PLANNING CODE PRIMARY DIAGNOSIS INDICATES ABORTION/ABORT CODE INVALID SECONDARY DIAGNOSIS INDICATES ABORTION/ABORTION CODE INVALID PRESCRIPTION / ORDER NUMBER IS MISSING MISSING OR INVALID QUANTITY DISPENSED NEW / REFILL NUMBER INVALID AUTHORIZED REFILLS NUMBER INVALID
NYS Department of Health Revised eMedNY edits - Reason Codes and Remark Codes
eMedNY System Edit 00532
00538 00539 00550 00556
00568 00598
Edit Definition DISPENSE AS WRITTEN CODE INVALID ORDERING/REFERRING PROVIDER PROFESSION CODE INVALID REFILL EXCEEDS MAXIMUM NUMBER AUTHORIZED PLAN LIMITATIONS EXCEEDED REFILL NUMBER EXCEEDS MAXIMUM PRESCRIBING PROVIDER PROFESSION CODE INVALID FOR ISSUING PRESCRIPTION CATEGORY OF SERVICE INVALID FOR NDC CODE ADMIT NUMBER MISSING
Old Reason Code
New Reason Code
B17
16
52
184
57 57
151 16
57
16
52
16
57
16
00663 00672 00703 00710 00712 00736 00737 00738
FAMILY PLANNING INDICATOR INVALID FOR BILLING PROVIDER INAPROPRIATE SECOND SERVICE SAME DAY PROCEDURE/FORMULARY CODE EXCEEDS SERVICE LIMITS PROC EXCEEDS SERVICE LIMITS DIAGNOSIS CODE BLANK A FULL ICD-9 CM CODE REQUIRED 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
NYS Department of Health Revised eMedNY edits - Reason Codes and Remark Codes
eMedNY System Edit
Edit Definition
00753
ONLY UPSTATE CONTRACTOR ALLOWED TO BILL FOR SERVICE
00803
PATIENT BORN IN HOSPITAL/YEAR OF BIRTH DIFFERS FROM ADMIT YEAR
00858
00897
00898
00899
ORDERING/REFERRING PROVIDER TYPE INVALID FOR SERVICE PRESCRIBING PROVIDER ID NOT ON MMIS PROVIDER FILE/PRESCRIBER TYPE BLANK PRESCRIBING PROVIDER CATEGORY OF SERVICE INVALID FOR PHARMACY ORDERING/REFERRING PROVIDER CATEGORY OF SVC INVALD FOR DME
Old Reason Code
New Reason Code
52
38
52
183
52
38
52
183
52
183
Old Remark Code
New Remark Code
MA38
N340
M68
N287
ORDERING OR REFERRING PROVIDER ID OR LICENSE NUMBER NOT ON CLAIM 00903 00936
00939 00941
00942 00944 01008
CLINIC SPECIALTY CODE NOT ON NEW YORK STATE MASTER FILE ORDERING/REFERRING PROVIDER EXCLUDED PRIOR TO SERVICE/ORDER DATE SERVICE PROVIDER EXCLUDED PRIOR TO SERV/ORDER DATE ORDERING/REFERRING PROVIDER DECEASED ON SERVICE/ORDER DATE SERVICE PROVIDER DECEASED ON SERVICE/ORDER DATE REFERRING PROVIDER PROFESSION CODE INVALID
NYS Department of Health Revised eMedNY edits - Reason Codes and Remark Codes
eMedNY System Edit 01009 01034 01077 01098
01127
Old Reason Code
Edit Definition REFERRAL DATA INCONSISTENT SPECIALTY CODE INVALID 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
New Reason Code
B6
170
B6
170
52
B7
52
38
01158
PART A DEDUCTIBLE PREVIOUSLY PAID FOR THIS SPELL OF ILLNESS ENHANCED FEE PROCEDURE CODE USED FOR NON-QUALIFIED RECIPIENT OR PROVIDER
01165
CHIROPRACTIC ORDER/REFERRAL INVALID FOR SERVICE
52
183
01166
CHIROPRACTIC ORDER/REFERRAL INVALID - RECIPIENT NOT QUALIFIED MEDICARE BENEFICIARY
52
177
52 52
22 183
47
12
B6
8
01129
01167 01183 01209 01220 01221
CHIROPRACTIC ORDER/REFERRAL INVALID - MEDICARE APPROVED AMOUNT NOT GREATER THAN ZERO REFERRAL INVALID FOR SERVICE DESIGNATED MENTAL ILLNESS DIAGNOSIS REQUIRED DAY TREATMENT RATE INVALID FOR PRINCIPLE PROVIDER CODE REFERRING ID BLANK - OMH REHABILITATION
PROVIDER NOT ALLOWED TO BILL FOR PORTABLE XRAY SERVICES CLAIM PROVIDER NOT EQUAL RESTRICTION RECIPIENT FILE PROVIDER P.T.CLINIC RATE BILLED/PROVIDER P.T. CLINIC NUMBER MISSING PROVIDER ID AND SERVICE ID IDENTICAL NO COVERAGE: PENDING FAMILY HEALTH PLUS OPTOMETRIST INDICATED NOT QUALIFIED TO PRESCRIBE RECIPIENT INELIGIBLE, EXCESS INCOME/SPENDDOWN MISSING OR INVALID ELIGIBILITY OVERRIDE CODE INVALID PIN DRUG-PREGNANCY INFERRED PRECAUTION MAJOR PROGRAM - SERVICE CONFLICT
