Remark code N104 indicates that the submitted claim or service is not eligible for payment because it falls outside the jurisdiction of the Medicare contractor to whom it was sent. To resolve this issue and find the appropriate Medicare contractor that has the authority to process the claim, providers should refer to the Centers for Medicare & Medicaid Services (CMS) website at www.cms.gov.
Common causes of code N104 are:
1. The healthcare provider submitted the claim to the wrong Medicare Administrative Contractor (MAC) based on the geographic jurisdiction.
2. The patient's address on file does not match the jurisdiction of the MAC to which the claim was submitted.
3. The provider's billing address or practice location is outside the service area of the MAC that received the claim.
4. The type of service or procedure code billed is not covered within the jurisdiction of the MAC that received the claim.
5. There may have been recent changes in MAC jurisdictions that the provider's office was not aware of, leading to the claim being sent to the previous contractor instead of the current one.
6. The claim was submitted for a beneficiary who has moved to a different jurisdiction without updating their address with Medicare, resulting in a mismatch.
7. The provider may have multiple practice locations and mistakenly submitted the claim under the wrong location's information.
8. The claim was submitted for a service that is specifically allocated to a different MAC, such as durable medical equipment or organ transplant services, which sometimes have designated MACs regardless of geographic location.
Ways to mitigate code N104 include ensuring that claims are submitted to the correct Medicare Administrative Contractor (MAC) based on the service location. This can be achieved by regularly updating your billing system with the latest jurisdiction information and training your billing staff to verify the appropriate MAC for each claim before submission. Implementing a pre-claim submission process that includes a jurisdiction check can also help prevent this code from occurring. Additionally, using advanced claim scrubbing software that flags potential jurisdiction errors can help catch and correct these issues before the claims are sent out. Regular audits of claim denials for code N104 can provide insights into patterns that may indicate a need for process improvements or additional staff training.
The steps to address code N104 involve verifying the correct Medicare Administrative Contractor (MAC) for the service location. Begin by consulting the CMS website to determine the appropriate MAC jurisdiction. Once identified, resubmit the claim to the correct MAC with the accurate service location information. Ensure that all other claim details are correct to prevent further rejections. If the claim has been submitted to the correct MAC and the code persists, contact the MAC directly for clarification and guidance on the necessary steps to resolve the issue.