Remark code N696 alerts healthcare providers of a reversal due to Coordination of Benefits or Third Party Liability retroactive adjustment.
Remark code N696 is an alert indicating that the reversal of the payment is due to a Coordination of Benefits (COB) or Third Party Liability (TPL) Recovery retroactive adjustment.
Common causes of code N696 are incorrect primary payer information submitted on the initial claim, changes in the patient's coverage not updated in the payer's system, retroactive adjustments made by a third-party liability insurer, or errors in the initial Coordination of Benefits (COB) information that necessitate a claim reversal and reprocessing.
Ways to mitigate code N696 include implementing a robust verification process for patient insurance coverage before services are rendered. This should involve confirming primary and secondary insurance details and understanding the coordination of benefits (COB) rules that apply to the patient's coverage. Regularly updating insurance information and ensuring accurate entry into the billing system can also prevent this issue. Additionally, establishing a communication protocol with third-party payers to quickly address and resolve any retroactive adjustments can help in avoiding this code. Training staff on the nuances of COB and third-party liability recovery, along with periodic audits of COB claims, can further reduce the occurrence of this code.
The steps to address code N696 involve a multi-faceted approach focusing on the coordination of benefits (COB) and third-party liability (TPL) aspects. Firstly, review the patient's account to identify any changes in their insurance coverage or benefits that might have occurred retroactively. This includes verifying the primary and secondary insurance details and ensuring that the claim was submitted to the correct payer in the proper order.
Next, if the reversal is due to an error in the initial COB or TPL information provided, correct the information and resubmit the claim with the updated details. It's crucial to include any supporting documentation that verifies the correct COB or TPL information, such as insurance cards, benefits statements, or letters from the insurance providers.
If the reversal is accurate and reflects a legitimate retroactive adjustment, adjust the patient's account accordingly. This may involve recalculating the patient's responsibility, taking into account any payments or adjustments made by the third-party payer. Communicate any changes in the patient's balance clearly and promptly, providing a detailed explanation of the reason for the adjustment.
Finally, to prevent similar issues in the future, consider implementing a more robust verification process for COB and TPL information at the time of service. This could involve additional training for staff on how to accurately collect and verify insurance information, as well as the use of technology to automate and streamline the verification process.
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