Remark code N112 indicates that this particular claim has been excluded from the electronic remittance advice (ERA) that is typically sent to healthcare providers to explain payments and adjustments made by payers. This means that details regarding the processing of this claim will not be found on the ERA, and additional follow-up may be necessary to obtain information about the claim's status or payment details.
Common causes of code N112 are:
1. The claim was processed manually, and the payer's system is set up to exclude manual claims from electronic remittance advice (ERA).
2. The provider's billing system may not be set up to receive ERAs, or there may be an error in the provider's electronic submission that prevents the ERA from being sent or received.
3. The payer may have an issue with their ERA delivery system, which could result in certain claims being excluded from the ERA output.
4. The claim may have been submitted for a service that is not covered under the electronic remittance advice agreement between the provider and the payer.
5. There may be a mismatch in the provider's information, such as the National Provider Identifier (NPI) or Tax Identification Number (TIN), which could lead to the exclusion of the claim from the ERA.
6. The payer may have specific criteria or thresholds for including claims in an ERA, and the claim in question might not meet these criteria.
7. The exclusion could be due to a temporary processing issue or system outage that affected the generation or transmission of the ERA for that particular claim.
Ways to mitigate code N112 include ensuring that your billing system is set up to receive electronic remittance advice (ERA) for all types of claims. Verify that your enrollment for ERA is current and that you have not inadvertently opted out or limited the types of claims for which you receive ERAs. Additionally, check with your clearinghouse or payer to confirm that there are no errors in the ERA enrollment process and that your provider information is accurate and up-to-date. Regularly review your ERA settings to ensure that all claims are included and that no exclusions have been set by mistake. If necessary, update your electronic billing software to the latest version to support all ERA transactions.
The steps to address code N112 involve first reviewing the payer's preferences and requirements for electronic remittance advice (ERA). Ensure that your billing system is set up correctly to receive ERAs according to the payer's specifications. If the setup is correct, contact the payer to clarify why the claim was excluded and request inclusion in future ERAs. Document the conversation and any instructions or solutions provided by the payer. If necessary, adjust your billing system or processes to align with the payer's requirements for ERA receipt. Keep track of any changes made and monitor subsequent claims to ensure they are included in the ERA as expected. If the issue persists, consider escalating the matter through the payer's provider relations or support channels to seek a resolution.