Remark code N108 indicates that the claim submitted lacks the necessary information, is incomplete, or contains invalid details regarding an upgrade. This typically refers to instances where additional information is required to substantiate the upgrade of a service or piece of equipment. The payer needs this information to process the claim appropriately.
Common causes of code N108 are:
1. The claim was submitted without the necessary information detailing the upgrade to a more expensive item or service.
2. The documentation provided does not clearly justify the medical necessity for the upgraded item or service.
3. The upgrade information section on the claim form was left blank or contains errors.
4. The claim lacks the required authorization or prescription for the upgraded service or item.
5. The patient's medical records do not contain sufficient detail to support the upgrade.
6. The upgrade information provided does not match the procedure codes or descriptions on the claim.
7. The electronic claim submission may have formatting errors that caused the upgrade information to be omitted or corrupted.
Ways to mitigate code N108 include ensuring that all documentation related to upgrades, such as advanced equipment or improved services, is thoroughly completed and accurately reflects the current status of the item or service. It's important to establish a meticulous review process to verify that all required upgrade information is present and valid before submitting claims. Staff training on the specific documentation requirements for upgrades can also help prevent this code from occurring. Regular audits of submitted claims can identify patterns of missing or incomplete information, allowing for corrective action to be taken. Additionally, implementing a robust electronic health record (EHR) system with built-in checks can alert staff to missing fields or inconsistencies related to upgrade information before claim submission.
The steps to address code N108 involve reviewing the patient's file to ensure that all necessary upgrade information is complete and accurately documented. If the information is missing, reach out to the appropriate party, which could be the patient, the provider who recommended the upgrade, or the medical equipment supplier, to obtain the required details. Once the information is gathered, update the claim with the correct upgrade information, ensuring that it aligns with the coding guidelines for the specific service or item provided. After updating the claim, resubmit it to the payer for processing. It's also advisable to audit your processes to prevent similar issues in future claims.