Remark code N765 is an explanation that the payer does not cover coinsurance charged by another insurer.
Remark code N765 is an indication that the payer does not cover the coinsurance amount that was assessed by a previous payer.
Common causes of code N765 are incorrect billing of secondary insurance when primary insurance has already assessed coinsurance, failure to update insurance coverage information leading to outdated payer details, and misinterpretation of the coordination of benefits which results in improper assignment of financial responsibility for coinsurance amounts.
Ways to mitigate code N765 include implementing a robust verification process to confirm coverage details and coinsurance obligations before services are rendered. Training staff to accurately identify and understand different payer policies regarding coinsurance can also help. Utilizing advanced billing software that flags potential coinsurance issues based on payer contracts prior to claim submission is another effective strategy. Regularly updating the payer information database ensures that the most current coverage details are used in billing processes. Additionally, establishing clear communication channels with patients about their coverage and potential out-of-pocket costs can prevent misunderstandings and streamline the payment collection process.
The steps to address code N765 involve a multi-faceted approach to ensure proper handling and resolution. Initially, it's crucial to verify the accuracy of the coinsurance amount assessed by the previous payer. This can be achieved by reviewing the Explanation of Benefits (EOB) received from the initial payer to confirm the coinsurance details. Following this, re-evaluate the patient's coverage details with the current payer, focusing on the specifics of their policy regarding coinsurance, especially in cases where secondary insurance is involved.
If the coinsurance charge is accurate and falls within the policy's non-covered services, communicate this information to the patient, providing a clear breakdown of the charges and the reason they are responsible for the coinsurance amount. It's also beneficial to explore any potential financial assistance programs or payment plans that could support the patient in managing these out-of-pocket expenses.
In parallel, consider conducting an internal audit of the billing process to ensure that such charges are correctly identified and communicated to patients upfront, minimizing surprises and disputes over coverage. This proactive approach not only addresses code N765 when it occurs but also contributes to refining the billing and communication processes to enhance patient satisfaction and streamline revenue cycle management.
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