Remark code N197 indicates that the subscriber, who is the individual holding the insurance policy, needs to provide updated insurance information directly to the insurance payer. This action is necessary for the claim to be processed correctly. The healthcare provider should inform the patient that they must contact their insurance company to update their records to avoid any delays or denials in claim processing.
Common causes of code N197 are outdated or incorrect subscriber information on file with the insurance payer, a lapse in the insurance coverage that has not been communicated to the provider, or a recent change in the subscriber's insurance plan that has not been updated in the payer's system. This may also occur if the subscriber has switched employers or experienced a life event that affects insurance coverage, such as marriage or the birth of a child, and the necessary updates have not been made with the insurance company.
Ways to mitigate code N197 include implementing a robust patient information verification process at every point of service. This can involve training front desk staff to request and confirm insurance details during patient check-in and scheduling regular insurance eligibility checks prior to appointments. Additionally, utilizing advanced software tools that flag when a patient's insurance information may be outdated can prompt proactive outreach to the patient to update their records. Establishing clear communication channels with patients to educate them on the importance of keeping their insurance information current can also help in preventing this code. Regularly updating and maintaining the accuracy of the patient's demographic and insurance information in the practice management system is essential.
The steps to address code N197 involve contacting the patient to obtain updated insurance information. Ensure that the patient is aware that their insurer requires them to update their details directly. Provide the patient with the payer's contact information and instructions on how to update their insurance information if necessary. Once the patient has confirmed that their insurance details have been updated with the payer, resubmit the claim with the new information. Keep a record of all communications with the patient for future reference and to demonstrate due diligence in resolving the issue.