Remark code N139 is an alert indicating that under Title 32 of the Code of Federal Regulations, Section 199.13, a non-participating provider does not have the right to appeal a dental advisor's opinion. If the provider disagrees with the determination, they can only appeal if the beneficiary explicitly appoints them in writing as their representative. To proceed with the appeal, the provider must submit a copy of the appointment letter, a signed statement detailing the disagreement, and any supporting documents, such as radiographs, to the beneficiary's dental insurance carrier within a 90-day period from the date of the initial letter.
Common causes of code N139 are:
1. The provider submitting the appeal is not a participating provider within the network and, according to 32 CFR 199.13, does not have the right to appeal on behalf of the beneficiary.
2. The provider has not been officially appointed in writing by the beneficiary to act as a representative in the appeal process.
3. The necessary documentation, such as a copy of the appointment letter, a signed statement of disagreement, and any relevant radiographs or information, has not been submitted to the dental insurance carrier within the required 90-day timeframe from the date of the initial determination letter.
Ways to mitigate code N139 include ensuring that the beneficiary appoints the provider in writing as their representative for the appeal process. This appointment should be obtained before submitting an appeal to the dental insurance carrier. The provider should also maintain a copy of the appointment letter, a detailed signed statement outlining the disagreement with the Dental Advisor's opinion, and any supporting documents such as radiographs and relevant information. These materials must be compiled and submitted within the specified 90-day period from the date of the initial determination letter to ensure compliance with the appeals process. It is also important to familiarize oneself with the specific appeals procedures of the insurance carrier to avoid any administrative errors that could result in the appeal being denied.
The steps to address code N139 involve several actions. First, if you are a non-participating provider who disagrees with the Dental Advisor's opinion, you must be appointed in writing by the beneficiary to act as their representative in the appeal process. To do this, obtain a written statement from the beneficiary designating you as their representative. Next, compile a comprehensive appeal packet. This packet should include a copy of the letter indicating code N139, the beneficiary's written statement appointing you as their representative, a detailed written statement from you explaining the specific points of disagreement with the Dental Advisor's opinion, and any supporting documents such as radiographs or other relevant information that substantiate your position. Ensure that this appeal packet is submitted to the subscriber's Dental insurance carrier within the specified 90-day timeframe from the date of the initial letter. It is crucial to adhere to this deadline to ensure that the appeal is considered timely.