Remark code N190 indicates that the claim submission is lacking a necessary contract indicator. This means that the payer requires additional information to determine how the services provided align with a specific contract or agreement. The healthcare provider must review the claim to identify and include the missing contract indicator before resubmission to ensure proper processing and reimbursement.
Common causes of code N190 are:
1. The claim was submitted without the required contract indicator that specifies the type of contract or agreement under which the services were provided.
2. Incorrect or incomplete electronic claim submission where the contract indicator field was left blank or not properly coded.
3. The billing software failed to include the contract indicator automatically, due to a setup or mapping error.
4. The provider is unaware of the necessity to include a contract indicator for certain payers or types of services.
5. Manual entry errors where the staff responsible for coding the claim omitted the contract indicator.
6. Misinterpretation of payer requirements, leading to the assumption that a contract indicator was not necessary for the claim in question.
7. Changes in payer policies regarding contract indicators that were not communicated effectively to the billing staff or not updated in the practice management system.
8. The contract indicator may have been included but was not recognized due to incompatible formats between the provider’s billing system and the payer’s claims processing system.
Ways to mitigate code N190 include implementing a thorough review process to ensure that all claims submitted include the necessary contract indicators. This can be achieved by training billing staff on the importance of including contract indicators and by using automated claim scrubbing software that flags claims missing this vital information before submission. Regular audits of claim submissions can also help identify patterns of missing information, allowing for corrective action to be taken. Additionally, maintaining up-to-date records of all contracts and their requirements can assist in preventing this issue. It's also beneficial to establish a checklist for claim submission that includes verification of the contract indicator as a required step.
The steps to address code N190 involve verifying the presence and accuracy of the contract indicator in the claim submission. First, review the patient's account to ensure that the correct insurance information has been captured, including the payer's contract details. If the contract indicator was indeed omitted, update the claim with the appropriate contract information. If the contract indicator is present but incorrect, correct the information to reflect the accurate contract details. Once the necessary adjustments are made, resubmit the claim to the payer for processing. It's also advisable to check your billing system to ensure that the contract indicator field is properly configured to prevent this issue from recurring in future claims.