Remark code N187 is an alert indicating that the healthcare provider has the option to request a written review of a claim or service within the specified time limits after receiving this notice. The provider should follow the instructions provided in their contract or the plan benefit documents to initiate this review process.
Common causes of code N187 are:
1. The claim was denied due to a specific contractual or policy provision.
2. The payer requires additional information to determine coverage for the service billed.
3. The service may not be covered under the patient's current benefit plan.
4. The claim submission did not meet the necessary criteria outlined in the provider's contract.
5. The payer identified an issue with the claim that may be resolved upon review or appeal.
6. The provider may have missed a deadline or other important requirement specified in the contract.
7. The payer may be indicating that there is a potential for coverage upon submission of additional supporting documentation.
8. The claim was processed according to the payer's guidelines, but the provider disagrees with the outcome.
Ways to mitigate code N187 include implementing a robust review system for all denials and remark codes as soon as they are received. Ensure that your billing team is well-versed in the appeals process and that they are aware of the time limits for submitting a review request. It's important to maintain organized records of all notices and correspondence related to claims, as this will streamline the review request process. Additionally, training staff to thoroughly check claims before submission for accuracy and completeness can help prevent this code by reducing the likelihood of errors that could lead to a denial requiring a review. Regular audits of claim submissions against contract or plan benefit documents can also help identify and correct any recurring issues that may lead to this remark code.
The steps to address code N187 involve initiating a written appeal. Begin by gathering all relevant documentation, including the original claim, the Explanation of Benefits (EOB), and any clinical notes or supporting evidence that justify the medical necessity of the services provided. Draft a clear and concise appeal letter that outlines the reasons for contesting the denial, referencing the specific details of the patient's case and the terms of the coverage as per the contract or plan documents. Ensure that the appeal is submitted within the timeframe specified by the payer to avoid missing the deadline. Keep a copy of all correspondence for your records and follow up with the insurance company if you do not receive a response within the standard review period.