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 N613 is an alert indicating that while the current claim was paid, there is an issue with the ordering provider's enrollment record that needs to be addressed. It advises the billing party to verify the accuracy of the ordering provider information submitted on the claim. If the information is accurate, the billing party should contact the ordering provider and instruct them to update their enrollment record. The code warns that future claims associated with this ordering provider will not be paid unless the enrollment record issue is resolved.
Common causes of code N613 are incorrect or outdated provider information submitted on the claim, failure of the ordering provider to update their enrollment records with the payer, or discrepancies between the information on the claim and the payer's records regarding the ordering provider's enrollment status.
Ways to mitigate code N613 include ensuring that the ordering provider's information on the claim is current and accurate before submission. Regularly verify the enrollment status of all ordering providers in your system to prevent outdated information. Implement a process to routinely check and update provider details, including their enrollment records with insurance payers. Additionally, establish a communication protocol with ordering providers to prompt them to update their enrollment records when necessary. This could involve setting up reminders or notifications for providers whose enrollment might be nearing expiration or has changed. By proactively managing and verifying provider information, future claims can be safeguarded against denial due to enrollment issues.
The steps to address code N613 involve a two-pronged approach focusing on verification and communication. Initially, review the claim to ensure that the ordering provider's information submitted is accurate, including checking for any typographical errors or outdated information. If inaccuracies are found, correct them and resubmit the claim if necessary. Concurrently, reach out to the ordering provider directly, informing them of the need to update their enrollment record with the relevant payer or Medicare enrollment database. Provide them with specific details regarding the alert received and emphasize the urgency due to the potential impact on future claims payments. Encourage the provider to act promptly and confirm once their enrollment record has been updated. Keep a record of this communication for future reference and follow up if needed to ensure compliance and prevent future issues with claims involving this provider.
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