Remark code N140 alerts providers they're not authorized OCONUS providers and outlines appeal steps if appointed by a beneficiary.
Remark code N140 is an alert indicating that the provider has not been recognized as an authorized Outside Continental United States (OCONUS) provider and is therefore not eligible to appeal. However, if the provider has been appointed in writing by the beneficiary to act as their representative, they may appeal the Dental Advisor's opinion. To do so, the provider must submit a copy of the letter, a signed statement detailing the disagreement, and any pertinent information to the subscriber's dental insurance carrier within a 90-day period from the date of the letter.
Common causes of code N140 are:
1. The provider has attempted to submit a claim for services rendered outside of the continental United States (OCONUS) without proper authorization or designation as an OCONUS provider.
2. There is a lack of written authorization from the beneficiary designating the provider as their representative for appeals, which is required for providers operating OCONUS.
3. The provider may have overlooked the process of registering or obtaining the necessary credentials to be recognized as an authorized OCONUS provider by the insurance carrier.
4. The claim was submitted with the expectation that the provider is an appropriate appealing party for an OCONUS service, but the insurance records do not reflect this authorization.
5. There may be an administrative error where the provider has the appropriate designation, but the information was not accurately reflected or updated in the insurance carrier's system.
Ways to mitigate code N140 include ensuring that your practice is properly registered and authorized as an OCONUS (Outside the Continental United States) provider with the relevant insurance carriers before submitting claims. This may involve completing specific applications, providing necessary documentation, and meeting all the requirements set forth by the insurance carriers for OCONUS providers. Additionally, maintain clear and open communication with patients about their responsibility to appoint you in writing as their representative for appeals, if necessary. Keep a copy of this written authorization on file and include it with any appeals to demonstrate your authority to act on the patient's behalf. Regularly review and update your provider status and authorization to ensure compliance with insurance requirements and avoid future denials associated with this code.
The steps to address code N140 involve several actions. First, verify if there is a written authorization from the beneficiary appointing you as their representative. If such documentation exists, gather it along with a signed statement detailing the points of disagreement with the Dental Advisor's opinion. Next, compile any additional relevant information that supports your case. Once all documentation is prepared, submit these materials to the subscriber's Dental insurance carrier. Ensure that this submission is completed within the 90-day timeframe specified in the letter to adhere to the appeals process guidelines. It's also advisable to keep copies of all correspondence and documentation for your records.
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