Remark code N360 is an alert indicating benefits were estimated without coordination of benefits. Submit primary payer info with the secondary claim.
Remark code N360 is an alert indicating that the coordination of benefits has not been calculated when estimating benefits for this pre-determination. It advises the submitter to include payment information from the primary payer when submitting the secondary claim.
Common causes of code N360 are incomplete or missing primary payer payment information on the secondary claim submission, failure to attach Explanation of Benefits (EOB) from the primary insurer, incorrect or incomplete coordination of benefits information, and errors in the electronic submission process that omit primary payer details.
Ways to mitigate code N360 include ensuring that all primary payer payment details are accurately collected and processed before submitting any claims to the secondary payer. This involves verifying the patient's coverage and benefits with the primary insurer, and obtaining and attaching the Explanation of Benefits (EOB) from the primary payer when submitting secondary claims. Additionally, implementing a double-check system to review all claims for completeness and accuracy before submission can help prevent this issue. Training staff on the importance of coordination of benefits and how to properly document and submit this information can also reduce the occurrence of this code.
The steps to address code N360 involve a multi-step process to ensure proper coordination of benefits (COB) and accurate claim submission. Initially, review the patient's insurance file to confirm the primary and secondary insurance details are up-to-date and correctly entered into the system. Next, obtain the payment information, including the Explanation of Benefits (EOB) from the primary insurer, which outlines what has been paid or denied. This information is crucial as it will be used to accurately calculate the patient's coverage and the amount the secondary insurance is responsible for.
Following this, prepare and submit the secondary insurance claim, ensuring to include the primary insurance's EOB as part of the documentation. It's important to double-check that all information is accurately reflected and that the claim form is filled out in accordance with the secondary payer's requirements to prevent any delays or denials.
After submission, monitor the claim status closely. If there are any discrepancies or further information is requested by the secondary insurer, respond promptly with the necessary documentation or clarification to expedite the processing of the claim.
Finally, once the secondary claim has been processed, update the patient's account accordingly to reflect the payments received and any remaining balance that is due. Communicate any outstanding amounts to the patient, providing a clear breakdown of the charges, payments, and adjustments that have been applied to their account.
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