Denial code N105

Remark code N105 indicates a claim was sent incorrectly for an RRB beneficiary and should be submitted to Palmetto GBA via the provided address or call for EDI details.

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What is Denial Code N105

Remark code N105 indicates that the claim or service has been incorrectly directed and should be submitted to the Railroad Retirement Board (RRB) beneficiary's specific carrier, which is Palmetto GBA. The correct mailing address for paper claims is P.O. Box 10066, Augusta, GA 30999. Additionally, for electronic claims processing, providers should contact Palmetto GBA at 888-355-9165 to obtain RRB EDI information.

Common Causes of RARC N105

Common causes of code N105 are:

1. The claim was submitted to the wrong insurance carrier when it should have been directed to the Railroad Retirement Board (RRB) intermediary, Palmetto GBA.

2. Electronic claims were not sent to the correct RRB EDI (Electronic Data Interchange) address, leading to misdirection.

3. The provider's billing staff may have been unaware of the patient's RRB coverage and submitted the claim to the standard Medicare Administrative Contractor (MAC) instead.

4. Incorrect or outdated payer information in the provider's billing system, resulting in claims being sent to the wrong address.

5. Failure to update the billing system with the specific requirements for RRB beneficiaries, which includes using a unique payer address and contact information.

6. A lack of proper claim routing protocols for patients with RRB benefits, leading to systematic errors in claim submission.

Ways to Mitigate Denial Code N105

Ways to mitigate code N105 include ensuring that claims for Railroad Retirement Board (RRB) beneficiaries are correctly identified and routed from the outset. This can be achieved by:

1. Training billing staff to recognize RRB beneficiaries based on their unique Medicare card, which typically has a prefix of "A," "D," "E," "GA," or "W" before the claim number.

2. Implementing a verification process within your practice management system to flag potential RRB claims before submission.

3. Establishing a protocol for double-checking the insurance information and payer responsibility for patients with RRB coverage during the patient intake process.

4. Utilizing electronic eligibility verification tools to confirm RRB coverage and obtain the correct billing address and EDI information for electronic claims.

5. Keeping updated with the latest RRB billing guidelines and ensuring that the billing software is programmed to automatically route RRB claims to the correct address or electronic submission path.

6. Regularly auditing claims to identify patterns of misdirected RRB claims and taking corrective actions to prevent future occurrences.

How to Address Denial Code N105

The steps to address code N105 involve several actions to ensure the claim is redirected to the appropriate party. First, confirm the beneficiary's coverage under the Railroad Retirement Board (RRB) and verify that the claim was indeed misdirected. Next, prepare to submit the claim to the correct address, which for paper claims is Palmetto GBA, P.O. Box 10066, Augusta, GA 30999. For electronic claims, contact the provided number, 888-355-9165, to obtain the necessary EDI information for proper submission. Ensure that all claim details are accurate and complete before resubmission to avoid further delays. Keep a record of the resubmission process, including any correspondence or confirmation numbers, in case follow-up is needed.

CARCs Associated to RARC N105

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