Remark code N790 indicates a provider or supplier lacks accreditation for the specific product or service billed.
Remark code N790 is an indication that the claim has been denied because the provider or supplier involved does not have the necessary accreditation to offer the specific product or service billed.
Common causes of code N790 are:
1. The provider or supplier has not completed the necessary accreditation process for the specific product or service they are billing for.
2. The accreditation for the provider or supplier has expired and has not been renewed.
3. There is a discrepancy or error in the provider's or supplier's accreditation information on file with the payer.
4. The provider or supplier has changed their service or product offerings and has not obtained the required accreditation for these new services or products.
5. The claim was submitted with incorrect provider information, leading to a mismatch with accredited provider records.
6. The accreditation body has revoked the provider's or supplier's accreditation due to non-compliance or other issues, but the provider or supplier has continued to bill for the product or service.
Ways to mitigate code N790 include ensuring that all healthcare providers and suppliers within your organization are fully accredited for the specific products or services they offer. This can be achieved by regularly reviewing and updating accreditation statuses and ensuring compliance with all relevant accreditation standards. Additionally, implementing a robust verification process before the delivery of any new service or product can prevent this issue. Training staff on the importance of accreditation and its impact on billing and revenue cycle processes is also crucial. Establishing a dedicated team to manage and monitor accreditation requirements and deadlines can further help in avoiding this code.
The steps to address code N790 involve a multi-faceted approach to ensure compliance and accreditation for the specified product or service. Initially, it's crucial to verify the accuracy of the code by reviewing the services or products provided against the accreditation requirements. If the code is accurate, the next step is to identify the accrediting body relevant to the product or service in question.
Following this, the provider should engage with the accrediting organization to understand the specific requirements and steps necessary for accreditation. This may involve completing an application, undergoing an evaluation process, and possibly making adjustments to the service or product to meet the accrediting body's standards.
Simultaneously, it's advisable to communicate with the payer to inform them of the steps being taken to address the accreditation issue. This can help maintain a good payer-provider relationship and may lead to temporary leniency while the accreditation process is underway.
Once the accreditation has been achieved, the provider must submit the necessary documentation to the payer to prove compliance. This should include the accreditation certificate and any other relevant documents requested by the payer.
Finally, it's essential to review and update internal processes to ensure that all future services or products are fully accredited before being offered. This may involve training staff on the accreditation requirements and establishing a compliance team to oversee adherence to these standards.
By following these steps, healthcare providers can effectively address code N790, ensuring that they meet the necessary accreditation standards and avoid future issues with payer claims.
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