Remark code N185 indicates that the healthcare provider should not resubmit the claim or service in question. This code is used to inform the provider that the payer has made a decision regarding the claim, and resubmission is not necessary or appropriate. It may be used in situations where the claim has been fully adjudicated and any further action by the provider would be redundant.
Common causes of code N185 are:
1. The claim has already been adjudicated, and any resubmission would be considered a duplicate.
2. The payer has identified the claim as final and no further action is required or will be considered.
3. The claim may have been adjusted or voided after the initial payment, and resubmission is not necessary.
4. The claim could be associated with a global period, during which resubmission for services is not allowed.
5. The services billed may have been included in a prior claim and resubmitting would result in an overlap or duplication of services.
6. The payer may have processed the claim based on a coordination of benefits (COB) and determined that no additional payment is due.
7. The claim may have been submitted for an informational purpose only, and no payment is expected.
8. There may be a contractual agreement or policy in place that prohibits resubmission of this type of claim or service.
Ways to mitigate code N185 include implementing a robust claim tracking system that alerts your billing staff when a claim has been flagged with this code. This system should prevent resubmission of the same claim. Additionally, training your staff to understand the reasons behind an N185 code can help them address the underlying issue before submitting the claim. It's also important to conduct regular audits of your claims processing to identify patterns that may lead to this code being assigned, allowing you to make proactive changes to your submission process. Establishing a clear line of communication with the payer can also help clarify the specific reasons for the code and how to avoid it in future submissions.
The steps to address code N185 involve a careful review of the claim to understand the reason behind the alert. First, check the Explanation of Benefits (EOB) or the Electronic Remittance Advice (ERA) for additional details or accompanying codes that might clarify why resubmission is not advised. Next, assess if the claim was denied due to a non-covered service, a benefit max-out, or if it's a duplicate of a previously processed claim. If the denial is due to an error on the initial claim, correct the error and consider contacting the payer to discuss the possibility of reopening the claim rather than resubmitting. If the claim was processed correctly, and the denial is valid, make a note in the patient's account to prevent future resubmissions and inform the appropriate department or personnel. It's also essential to educate the billing staff to recognize this code and understand the protocol to avoid unnecessary work and potential delays in other claim processing.