Remark code N155 alerts providers that records lack other insurance info, prompting submission for accurate billing.
Remark code N155 is an alert indicating that the payer's records do not show evidence of other insurance coverage for the patient. The payer is requesting that the healthcare provider submit information regarding any additional insurance the patient may have to update their records accordingly. This is important for coordination of benefits and to ensure that all potential payment sources are considered before the claim is processed.
Common causes of code N155 are:
1. Failure to update the patient's insurance information in the provider's electronic health records (EHR) or billing system.
2. Inaccurate or incomplete patient intake forms that omit details of secondary or tertiary insurance coverage.
3. Administrative oversight in not asking the patient about additional insurance during the registration process.
4. Technical errors in data transfer where existing secondary insurance information fails to populate in the claim file.
5. The patient may have recently acquired secondary insurance that has not yet been communicated to the healthcare provider.
6. The insurance information may have been provided, but it was not entered into the system due to clerical errors.
7. The patient's other insurance may have lapsed or changed, and the current records have not been updated to reflect this change.
8. Miscommunication between the patient and the healthcare provider regarding the responsibility to inform the provider of any other insurance coverage.
9. Incorrect processing of previous claims where other insurance was involved, leading to an assumption of no other insurance on file for subsequent claims.
10. Delays in the insurance verification process, where verification of other insurance has not been completed by the time the claim is submitted.
Ways to mitigate code N155 include implementing a thorough insurance verification process before rendering services. This process should involve collecting all relevant insurance information from the patient, including primary and secondary coverage details. Staff should be trained to ask for and update insurance information at every patient encounter. Utilizing electronic eligibility tools can also help to automatically verify and update insurance records in real-time. Additionally, maintaining open communication with patients to remind them to report any changes in their insurance coverage can prevent this code from occurring. Regular audits of patient files to ensure that insurance information is current and accurate can also be beneficial.
The steps to address code N155 involve verifying the patient's insurance information. Begin by reviewing the patient's file to ensure that all current and active insurance policies are accurately documented. If other insurance exists, update the patient's record with the correct information, including policy numbers and insurance company contact details. Next, resubmit the claim with the updated insurance information. If the patient does not have other insurance, confirm this with the patient directly and document the conversation in their file. Then, communicate with the insurance company to clarify that no other insurance is on file for the patient and resubmit the claim if necessary. It may also be beneficial to include a note or an attachment with the resubmission to prevent the recurrence of this remark code.
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