Remark code N179 indicates that the payer requires additional information from the patient (member) to process the claim. Once the requested information is provided by the patient, the payer will reevaluate the charges for potential reimbursement.
Common causes of code N179 are incomplete patient information on file, missing documentation such as a referral or prior authorization, or a lack of necessary clinical details to support the medical necessity of the service or procedure billed. This code may also be triggered when specific forms or questionnaires required by the payer have not been completed by the patient.
Ways to mitigate code N179 include implementing a robust patient information collection process at the point of service. Ensure that all required forms, consents, and questionnaires are completed thoroughly and accurately. Train staff to verify patient information and insurance details during check-in, and establish a protocol for following up with patients to obtain any missing information promptly. Utilize electronic health records (EHR) systems to flag incomplete patient data and set reminders for staff to request additional information well before claims submission. Regularly review and update your information request templates and procedures to align with payer requirements, and consider implementing a patient portal that allows patients to upload requested information directly. Engage with patients to educate them on the importance of providing complete and timely information to avoid delays in claim processing.
The steps to address code N179 involve initiating a request for the additional information specified from the patient. This may include reaching out to the patient directly or coordinating with the patient's care team to obtain the necessary documentation or details. Once the information is received, it should be reviewed for completeness and relevance before submitting it to the payer for reconsideration of the charges. Ensure that the submission is done within the timeframe specified by the payer to avoid delays or denials due to untimely filing. It's also important to document all communications and submissions in the patient's account for future reference.