Remark code N373 indicates a refund to the payer who incorrectly paid services as primary, due to another payer being identified as primary.
Remark code N373 is an indication that the services were initially paid by another payer under the assumption that they were the primary payer, which was later found to be incorrect. As a result, a refund is being issued to the payer that mistakenly made the payment as the primary insurer.
Common causes of code N373 are:
1. Incorrect coordination of benefits information leading to the wrong payer being billed as primary.
2. Failure to update the beneficiary's coverage information, resulting in outdated or incorrect primary payer details.
3. Miscommunication between payers regarding their respective responsibilities for the claim.
4. Errors in the claims submission process, such as incorrect patient identifiers or insurance information, leading to misidentification of the primary payer.
5. Lack of verification of other insurance coverage before submitting the claim, assuming the payer on file is the primary without confirmation.
6. Changes in the beneficiary's insurance coverage not being communicated or updated in the provider's billing system in a timely manner.
Ways to mitigate code N373 include implementing a robust verification process for determining the primary and secondary payers before submitting claims. This can involve regularly updating and reviewing the patient's insurance information, utilizing payer coordination of benefits agreements, and employing software that automatically checks and updates payer order based on the latest eligibility data. Training staff on the importance of accurate insurance information collection and on how to effectively communicate with patients and insurance companies about coverage details can also reduce the occurrence of this code. Additionally, conducting periodic audits of claims before submission to ensure that the payer sequence is correctly identified can help in preventing this issue.
The steps to address code N373 involve a multi-faceted approach to ensure accurate payment processing and to rectify the misallocation of primary payer responsibility. Initially, conduct a thorough review of the patient's insurance information to confirm the correct primary and secondary payers. This includes verifying the patient's coverage details and the coordination of benefits. Following this, reach out to the payer that was incorrectly designated as primary to discuss the refund process, ensuring to provide all necessary documentation that supports the claim that they were not the primary payer.
Simultaneously, contact the correct primary payer to re-submit the claim with a detailed explanation of the error and the steps taken to rectify it, including evidence of the refund to the initially incorrect primary payer. This should be accompanied by a clear statement of the claim's legitimacy for coverage under their policy as the primary payer.
Throughout this process, maintain detailed records of all communications and transactions related to addressing code N373. This includes dates of conversations, names of individuals spoken with, and any reference numbers related to the claim or refund process. These records will be crucial for any follow-up actions and to ensure transparency and accountability in the resolution process.
Finally, review your internal processes for identifying primary and secondary payers to prevent similar issues in the future. This may involve additional training for staff or adjustments to your billing software to better manage and verify insurance information before claims submission.
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