Remark code N245 indicates a claim was denied due to incomplete or invalid plan information for other insurance.
Remark code N245 indicates that the claim submitted has incomplete or invalid information regarding the patient's other insurance plan. This means that additional details are required or corrections are needed for the secondary or tertiary insurance information provided on the claim. The healthcare provider must review and update the insurance information to ensure accurate coordination of benefits and facilitate proper claim processing.
Common causes of code N245 are:
- Missing or incorrect other insurance information on the claim form, such as policy numbers or group numbers.
- Failure to provide complete details about the secondary or tertiary insurance plan when the patient has multiple coverage.
- Submission of claims to the primary insurer without indicating the existence of additional insurance coverage.
- Incorrect sequencing of insurance when the patient has more than one policy, leading to confusion about which insurer should be billed first.
- Outdated or expired insurance information that has not been updated in the patient's record or on the claim.
- Data entry errors when inputting insurance information, such as transposed digits or misspelled names.
- Lack of coordination of benefits information, which is necessary to determine the responsibilities of each insurance plan.
- Inadequate communication between healthcare providers and patients regarding their current insurance coverage details.
Ways to mitigate code N245 include ensuring that all patient insurance information is thoroughly verified and updated at each visit. Implement a double-check system where a second staff member reviews the insurance details entered into the system. Utilize electronic eligibility verification tools to confirm coverage details in real-time before services are rendered. Train staff to recognize common errors and omissions in insurance information and to ask specific questions that can uncover inaccuracies or changes in a patient's coverage. Establish a protocol for patients to confirm their insurance information prior to their appointment, such as through pre-visit phone calls or secure electronic communications. Regularly audit insurance information entries to identify patterns that may lead to this code and address them through targeted training or process improvements.
The steps to address code N245 involve verifying and updating the secondary or tertiary insurance information on file. Begin by reviewing the patient's insurance information in your practice management system to ensure that all necessary fields are complete and accurate. This includes the policy number, group number, payer ID, and the insurance company's contact information. If any details are missing or incorrect, reach out to the patient to obtain the correct information. Once you have the updated details, resubmit the claim with the complete and accurate insurance information. Additionally, document the communication with the patient and any changes made to the insurance information in the patient's record to prevent future occurrences of this code.
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