Denial code M5

Remark code N170 indicates that a current certificate of medical necessity must be updated or replaced for billing.

Remark code N171 indicates that payment for repair or replacement is not covered or exceeds the item's original cost.

Remark code N172 indicates that the patient is not responsible for payment of denied or adjusted charges for updated services or items.

Remark code N173 indicates that claim processing is incomplete due to missing hospital stay dates for the care episode.

Remark code N174 indicates a service or item isn't covered, but patient financial responsibility is capped at the adjustment amount listed under 'PR'.

Remark code N175 indicates a claim denial due to the absence of necessary approval from the review organization.

Remark code N176 indicates coverage for services on a US-registered ship is limited to when it's in US waters and provided by a US-licensed doctor.

Remark code N177 indicates a claim wasn't sent to the secondary insurer as no further payment is expected from them.

Remark code N178 indicates a claim denial due to missing pre-operative images or visual field results required for processing.

Remark code N179 indicates that further details are needed from the patient for claim reconsideration.

Remark code N180 indicates an item or service doesn't meet the billing category criteria. Ensure correct coding to avoid claim denials.

Remark code N181 indicates that further details are needed from a different provider who participated in the service for billing.

Remark code N182 indicates that the claim/service must adhere to the specific billing schedule of the patient's insurance plan.

Remark code N183 indicates a predetermination advisory, signaling that extra documentation will be needed to process benefits when the service is billed.

Remark code N184 indicates that providers must rebill technical and professional components of a service as separate claims.

Remark code N185 indicates that the claim/service should not be resubmitted as it has been processed and further action is not required.

Remark code N186 indicates a Non-Availability Statement (NAS) is needed for the service and advises contacting a Military Treatment Facility.

Remark code N187 indicates a review request can be made within the specified time after notice receipt per contract or plan documents.

Remark code N188 indicates the procedure code submitted doesn't align with the approved care level.

Remark code N189 indicates a one-time exception payment for a service not typically covered under the plan's benefits.

Remark code N19 indicates that the billed service is considered incidental to the primary procedure performed.

Remark code N190 indicates a claim was rejected due to a missing contract indicator, which is essential for processing.

Remark code N191 indicates that the provider needs to update insurance details directly with the insurance payer for claims processing.

Remark code N192 indicates that the patient has Medicaid or is a Qualified Medicare Beneficiary, impacting billing.

Remark code N193 indicates a service may be covered by a specific federal, state, or local program, suggesting an alternate payer.

Remark code N194 indicates denial of payment for technical components when the provider doesn't own the equipment utilized.

Remark code N195 indicates that the technical part of a service must be billed independently from the professional component.

Remark code N196 indicates that the patient may have other insurance coverage that should be considered primary.

Remark code N197 indicates that the subscriber needs to provide updated insurance details directly to the insurance payer.

Remark code N198 indicates that the billing provider must be associated with the listed pay-to provider for claim payment.

Remark code N199 indicates a payer has approved extra payment or recoupment following their review or audit.

Remark code N2 indicates an allowance adjustment based on the plan's most appropriate treatment provision.

Remark code N20 indicates a service isn't payable when billed with another service on the same date.

Remark code N200 indicates that the professional part of a service must be billed separately for accurate payment.

Remark code N202 indicates that further details or explanations will be provided in a separate communication.

Remark code N203 indicates an error due to missing, incomplete, or invalid anesthesia time or units on a claim.

Remark code N204 indicates a service is being reviewed for a pre-existing condition; providers must submit the past year's medical records.

Remark code N205 indicates that the information submitted was not readable and needs clarification for processing.

Remark code N206 indicates that the documentation provided doesn't align with the claim details, potentially affecting reimbursement.

Remark code N207 indicates an error due to missing, incomplete, or invalid weight information in a claim submission.

Remark code N208 indicates an issue with the claim due to a missing, incomplete, or invalid Diagnosis-Related Group (DRG) code.

Remark code N209 indicates a claim issue due to a missing, incomplete, or invalid taxpayer identification number.

Remark code N21 indicates that an item on a claim has been split into multiple lines for faster processing.

Remark code N210 indicates a decision that can be appealed by healthcare providers for claim resolution.

Remark code N211 indicates that the decision is final and cannot be appealed by the healthcare provider.

Remark code N212 indicates charges were processed under a Point of Service benefit plan.

Remark code N213 indicates a claim issue due to missing or invalid DRG status info for a specific facility or unit.

Remark code N214 indicates a claim denial due to missing or invalid history of initial surgical procedures.

Remark code N215 indicates that secondary payers won't need a primary payer's claim decision to process their own claim for a service.

Remark code N216 indicates a service isn't covered or the patient isn't enrolled in the relevant benefit package.

Remark code N217 indicates that reimbursement is limited to one service location per provider for each claim submitted.

Remark code N218 indicates that the provider must supply and service an item as long as needed, with maintenance costs covered as per the contract.

Remark code N219 indicates a payment adjustment based on the allowed amount from a previous insurance payer.

Remark code N22 indicates a procedure code update to better reflect services provided, aiding accurate billing and reimbursement.

Remark code N220 indicates a need to visit the payer's website or contact their Customer Service for forms and instructions to file a provider dispute.

Remark code N221 indicates a claim denial due to a missing Admitting History and Physical report.

Remark code N222 indicates an incomplete or invalid Admitting History and Physical report in healthcare claims.

Remark code N223 indicates a claim denial due to missing evidence of patient benefit in the initial treatment period.

Remark code N224 indicates a claim denial due to incomplete or invalid documentation of patient benefit during initial treatment.

Remark code N226 indicates an issue with the ADA Certificate of Recognition, requiring validation or completion for processing.

Remark code N227 indicates an incomplete or invalid Certificate of Medical Necessity on a healthcare claim.

Remark code N228 indicates a claim denial due to an incomplete or invalid consent form submission in the billing process.

Remark code N229 indicates an issue with a claim due to an incomplete or invalid contract indicator in healthcare billing.

Remark code N23 indicates potential changes in patient liability due to benefits coordination with other insurers or benefit caps.

Remark code N230 alerts providers that a claim lacks valid confirmation of patient-owned equipment needing parts or supplies.

Remark code N231 indicates an invalid or incomplete invoice/statement for the cost of a lens or the type of intraocular lens used.

Remark code N232 indicates an incomplete or invalid itemized bill/statement, requiring correction for claim processing.

Remark code N233 indicates an incomplete or invalid operative note/report, requiring action for proper claim processing.

Remark code N234 indicates an incomplete or invalid oxygen certification or re-certification in a claim submission.

Remark code N235 indicates a claim issue due to an incomplete or invalid pacemaker registration form.

Remark code N236 indicates an incomplete or invalid pathology report, requiring review or additional information for claims processing.

Remark code N237 indicates an incomplete or invalid patient medical record for a specific service, requiring action for proper billing.

Remark code N238 indicates a claim was denied due to an incomplete or invalid physician-certified plan of care.

Remark code N239 indicates an issue with a claim due to an incomplete or invalid physician financial relationship form.

Remark code N24 indicates a claim issue due to missing or invalid EFT banking details, requiring action for payment processing.

Remark code N240 indicates a claim denial due to an incomplete or invalid radiology report.

Remark code N241 indicates a claim denial due to incomplete or invalid review organization approval.

Remark code N242 indicates a claim denial due to incomplete or invalid radiology films or images submitted.

Remark code N243 indicates a claim denial due to an incomplete, invalid, or unapproved screening document.

Remark code N244 indicates a claim denial due to incomplete or invalid pre-operative images or visual field results.

Remark code N245 indicates a claim was denied due to incomplete or invalid plan information for other insurance.

Remark code N246 indicates that state-regulated payment limits apply to the billed healthcare service.

Remark code N247 indicates an issue with the assistant surgeon's taxonomy, such as missing or incorrect information.

Remark code N248 indicates a claim issue due to a missing or invalid assistant surgeon's name, requiring correction for processing.

Remark code N249 indicates an issue with the assistant surgeon's primary identifier, such as missing or invalid details.

Remark code N25 indicates a third-party administrator handles claims but doesn't bear financial responsibility for your benefit plan.

Remark code N250 indicates an issue with the assistant surgeon's secondary identifier, such as missing or invalid details.

Remark code N251 indicates an issue with the claim: the attending provider's taxonomy code is missing, incomplete, or invalid.

Remark code N252 indicates an issue with a claim due to a missing or invalid attending provider's name, requiring correction.

Remark code N253 indicates a claim issue due to a missing or invalid attending provider's primary identifier.

Remark code N254 indicates an issue with a missing or incorrect secondary identifier for the attending provider in a claim.

Remark code N255 indicates an issue with the claim due to missing or invalid billing provider taxonomy information.

Remark code N256 indicates an issue with the claim due to a missing or invalid billing provider/supplier name.

Remark code N257 indicates an issue with the billing provider's primary identifier, such as missing or incorrect details.

Remark code N258 indicates an error due to a missing, incomplete, or invalid address for the billing provider or supplier.

Remark code N259 indicates an issue with a secondary identifier for the billing provider/supplier, requiring correction.

Remark code N26 indicates a claim was denied due to a missing itemized bill or statement, requiring submission for processing.

Remark code N260 indicates a claim was denied due to missing or incorrect billing provider contact information.

Remark code N261 indicates an issue with a claim due to a missing or invalid operating provider name.

Remark code N262 indicates an issue with the operating provider's primary identifier, such as it being missing or incorrect.