Denial code N543

Remark code N542 is an alert indicating that the patient's income verification is missing from their documentation.

Remark code N544 is an alert that payment was made despite a mismatch in the referring/ordering provider details, warning of future denial if uncorrected.

Remark code N545 is an alert indicating payment reduction due to the provider's status as an unsuccessful e-prescriber under the eRx Incentive Program.

Remark code N546 is an explanation for reduced payment due to prior adjustments from the eRx Incentive Program.

Remark code N547 indicates a previously processed refund request associated with Frequency Type Code 8.

Remark code N548 indicates the patient's annual deductible is fulfilled, impacting claim processing and payment.

Remark code N549 indicates the patient's yearly out-of-pocket expense limit has been reached, impacting billing.

Remark code N55 indicates that billing procedures for group/referring/performing providers were incorrect.

Remark code N550 alerts providers that failure to revalidate enrollment info will soon lead to a payment hold.

Remark code N551 is an adjustment notice for payments based on the ASC Quality Reporting Program criteria.

Remark code N552 is an adjustment notice reversing a prior withhold or bonus, impacting your payment balance.

Remark code N554 is an alert indicating the absence or error in the Family Planning Indicator on a claim submission.

Remark code N555 is an alert indicating a claim's denial due to an absent medication list, requiring submission for processing.

Remark code N556 is an alert indicating the medication list provided is either incomplete or invalid, requiring attention.

Remark code N557 indicates a claim/service is not payable due to being outside the service area. It must be filed to the correct Payer/Plan.

Remark code N558 is an alert that the claim isn't payable in the current service area and must be filed to the correct Payer/Plan.

Remark code N559 is an alert that the claim isn't payable in the current service area and must be filed to the correct Payer/Plan.

Remark code N56 indicates an error where the procedure code used does not match the service provided or the date of service.

Remark code N560 is an alert that a claim must be submitted within 60 days of admission, as per the pilot program's rules.

Remark code N561 indicates a bundled claim for an episode of care includes related readmissions, allowing resubmission for corrected payment.

Remark code N562 is an alert that the provider number on your claim doesn't match the NOA's provider number for bundled payment.

Remark code N563 is an alert indicating a provider's failure to issue advance notice of non-coverage, absolving the patient from payment responsibility.

Remark code N564 is an explanation that the patient didn't qualify for the specific demo project or pilot program.

Remark code N565 alerts that a non-payable reporting code needs a modifier. Future claims must include it for processing.

Remark code N566 alerts that a procedure code needs functional reporting. Future claims must have a non-payable code and modifiers for processing.

Remark code N567 is an explanation for services not covered due to their preventative nature.

Remark code N568 is an alert for initial payment based on the Notice of Admission under the Bundled Payment Model IV initiative.

Remark code N569 is an explanation that a service isn't covered due to the specific diagnosis reported.

Remark code N57 indicates a claim denial due to a missing, incomplete, or invalid prescribing date.

Remark code N570 indicates missing, incomplete, or invalid credentialing data in healthcare billing submissions.

Remark code N571 indicates that payment will be made quarterly by a different payer or contractor, affecting claim processing.

Remark code N572 indicates a procedure is not payable without the correct non-payable reporting codes and modifiers.

Remark code N573 is an alert indicating an overpayment has been made and a refund is required, with a separate request from another payer.

Remark code N574 indicates the provider's type/specialty cannot order/refer. Verify claim info or contact the provider for accuracy.

Remark code N575 is an alert indicating a discrepancy between the submitted and recorded names of the ordering/referring provider.

Remark code N576 indicates services billed are unrelated to the incident/claim/accident/loss specified in the report.

Remark code N577 indicates that the claim involves Personal Injury Protection (PIP) Coverage.

Remark code N578 is an explanation from insurers indicating the provided coverages do not apply to the specific claim submitted.

Remark code N579 is an indicator that the claim involves Medical Payments Coverage (MPC) issues.

Remark code N58 indicates an issue with the patient liability amount, such as missing, incomplete, or invalid data in a claim.

Remark code N580 is an explanation for insurance claim decisions based on specific policy provisions.

Remark code N581 indicates that the investigation into the patient's coverage eligibility is currently ongoing.

Remark code N582 is an alert that benefits are on hold until the patient provides necessary cooperation.

Remark code N583 indicates coverage denial as the patient wasn't an occupant of the insured vehicle, thus ineligible for benefits.

Remark code N584 is an indication that a service is not covered due to the insured's failure to meet policy conditions.

Remark code N585 is an alert that benefits have ceased due to a final injury settlement.

Remark code N586 is an alert indicating the injured party is ineligible for benefits due to qualification criteria.

Remark code N587 indicates that the patient's insurance policy benefits have been fully used up.

Remark code N588 indicates that the patient has directed that their medical claims or bills should not be processed for payment.

Remark code N589 is an explanation for denied insurance coverage due to injuries from operating a vehicle under the influence.

Remark code N59 alerts healthcare providers to consult their manual for specific program and provider details.

Remark code N590 is an alert indicating the absence of an independent medical exam report detailing injury causes and service necessity.

Remark code N591 is an indication that payment is adjusted based on an Independent Medical Examination (IME) or Utilization Review (UR).

Remark code N592 is an adjustment notice for prescriptions not initial or exceeding the allowed amount for the first prescription.

Remark code N593 is an indication that a claim isn't covered due to missing a scheduled Independent Medical Exam (IME).

Remark code N594 is an alert indicating the injured party failed to complete a Benefits Application for the reported loss.

Remark code N595 indicates the injured party failed to complete an Assignment of Benefits for the reported loss.

Remark code N596 indicates the injured party failed to complete a Medical Authorization for the reported loss.

Remark code N597 is an adjustment due to the division of care costs between related injuries and other unrelated health conditions.

Remark code N598 is an indicator that the patient's health care policy is the primary coverage for billing purposes.

Remark code N599 indicates payment is based on a reasonable amount, considering usual charges, policy terms, and the Florida No-Fault Statute, at 200% of Medicare Part B fees.

Remark code N6 indicates that payment for covered care is limited to what Medicare Part A/B would allow under FEHB law (U.S.C. 8904(b)).

Remark code N600 is an adjustment notice indicating billing aligns with the regional fee schedule where service was provided.

Remark code N601 is a notification that payment aligns with Hawaii's specific Medicare Resource Based Relative Value Scale System.

Remark code N602 is an adjustment notice indicating billing exceeds the Redbook's maximum allowed price for a service or item.

Remark code N603 indicates the fee is based on New Jersey's medical schedules for Auto Injury Protection and Motor Bus Medical Coverage.

Remark code N604 is an explanation for a base fee adjustment in NY, calculated as per Regulation 68, following the NY Workers' Compensation Board Schedule.

Remark code N605 is an explanation that the fee was set based on NY APR-DRG, as required by Regulation 68.

Remark code N606 indicates the Oregon allowed amount for a procedure is based on the Workers Compensation Fee Schedule, as per ORS 742.524.

Remark code N607 is an alert indicating service was for a condition not covered by the insurance plan.

Remark code N608 indicates the fee allowed is 110% of the Medicare Fee Schedule for the region, specialty, and service, in line with Act 6.

Remark code N609 indicates that 80% of the billed amount is recommended for payment as per Act 6 guidelines.

Remark code N61 indicates that services should be rebilled on separate claims for proper processing.

Remark code N610 indicates payment adjustments due to services not matching the required care level.

Remark code N611 indicates a claim is under litigation. Providers should contact the insurer for further details.

Remark code N612 is an alert that the provider is not certified to treat injured workers in the specified area.

Remark code N613 is an alert that payment was made, but the ordering provider's enrollment needs updating. Verify and act to ensure future payments.

Remark code N614 is an alert indicating extra details are in the 835 Healthcare Policy ID Segment, loop 2110 Service Payment Info.

Remark code N615 is an alert indicating an enrollee in a 3-month grace period for premium non-payment, with specific claim handling rules.

Remark code N616 alerts healthcare providers that the enrollee is in the first month of their advance premium tax credit grace period.

Remark code N617 indicates an enrollee is in the 2nd or 3rd month of the advance premium tax credit grace period.

Remark code N618 alerts healthcare providers that the claim will be reprocessed once the enrollee pays their premiums.

Remark code N619 is an alert indicating insurance coverage was ended due to unpaid premiums.

Remark code N62 indicates a claim spans multiple rate periods, requiring resubmission as separate claims for accurate processing.

Remark code N620 alerts that the procedure code is used solely for quality reporting or informational purposes, not billing.

Remark code N621 indicates that charges for required forms, reports, or chart notes by jurisdiction are not covered.

Remark code N622 is an explanation for services not covered due to the date of the injury or accident.

Remark code N623 is an explanation for denial, indicating a service is not covered due to being unproven or inappropriate.

Remark code N624 indicates the related Workers' Compensation claim has been retracted by the claimant or payer.

Remark code N625 indicates a claim issue due to a missing, incomplete, or invalid Workers' Compensation Claim Number.

Remark code N626 indicates E/M codes for new or established patients are not billable alongside chiropractic care codes.

Remark code N628 indicates that follow-up outpatient visits on the same day as a scheduled test or treatment are not permitted.

Remark code N629 indicates that additional reviews, documentation, notes, summaries, reports, or charts were not requested.

Remark code N63 indicates that services should be rebilled on separate claim lines for proper processing.

Remark code N630 indicates a claim denial due to lack of referral authorization from the attending physician.

Remark code N631 indicates a service code isn't listed in the Medical Fee Schedule, but an allowance was made for a similar service.

Remark code N633 is an alert that extra time units for anesthesia services are not permitted in billing.

Remark code N634 is an explanation that payment is based on calculated anesthesia time units.

Remark code N635 is an explanation for how anesthesia allowances are determined by base units and time.