Remark code N123 indicates that the service billed has been divided and is being reported as a partial component of the units that were initially submitted for payment. This alert signifies that the payer has recognized the service as being split for the purposes of processing and reimbursement.
Common causes of code N123 are:
1. The service billed was divided into separate parts for reporting purposes, and the units charged on the claim reflect only a portion of the entire service provided.
2. The claim was submitted with a total number of units that exceeded the allowable amount for a single service date, prompting the payer to split the service into allowable unit increments.
3. The procedure performed may have been a combination of services that are typically billed together, but due to payer rules or specific circumstances, they had to be split and billed separately.
4. The provider may have incorrectly reported the units, leading the payer to adjust the claim to reflect the portion of the service that aligns with their coverage guidelines.
5. There may have been an error in the initial claim submission where the units were not clearly defined, resulting in the payer interpreting the service as requiring a split.
6. The payer's claims processing system automatically splits services based on predefined rules or edits, which may not always align with the provider's understanding of how the service should be billed.
Ways to mitigate code N123 include ensuring that billing for services that can be split is done accurately according to the units of service provided. It's important to review the Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) codes to determine if the service is billable in multiple units or as a single service. Additionally, maintain clear documentation that justifies the service units billed and verify that the claim form reflects the correct number of units for the portion of the service provided. Regularly train billing staff on the proper procedures for split billing to avoid this issue. If the service is commonly split, consider implementing a billing system feature that automatically flags these services for review before submission.
The steps to address code N123 involve reviewing the claim to verify that the service was correctly split and that the units billed correspond accurately to the portion of the service provided. If the split is accurate, resubmit the claim with any necessary adjustments to the units or service dates. If the split is incorrect, consolidate the services into a single claim with the appropriate total units and resubmit. Ensure that documentation supports the split service and is readily available in case the payer requests additional information to justify the division of services. If the code persists after resubmission, contact the payer directly to clarify the issue and seek guidance on how to proceed.