Remark code N253 indicates that the claim submitted lacks a valid primary identifier for the attending provider, or the information provided is incomplete or incorrect. This identifier is crucial for the payer to process and adjudicate the claim, as it uniquely identifies the healthcare professional who delivered the care. To resolve this issue, the healthcare provider must review the claim, ensure that the attending provider's National Provider Identifier (NPI) or other required identifier is present, accurate, and formatted correctly, and then resubmit the claim for payment consideration.
Common causes of code N253 are:
1. The attending provider's National Provider Identifier (NPI) is not included on the claim.
2. The NPI provided on the claim is incorrect or does not match the provider information on record.
3. The claim form is missing the required field for the attending provider's primary identifier.
4. The attending provider's primary identifier is incomplete, such as a truncated or partially entered NPI.
5. The claim was submitted with an outdated or invalid NPI due to changes in the provider's information that were not updated in the payer's system.
6. The attending provider's information was entered in the wrong section or field of the claim form, leading to rejection for being improperly formatted.
7. The claim was submitted electronically, and there was an error in the electronic data interchange (EDI) transmission that caused the provider's identifier to be omitted or corrupted.
Ways to mitigate code N253 include implementing a robust verification process to ensure that all claims include the correct and complete primary identifier for the attending provider. This can be achieved by:
1. Training staff on the importance of capturing accurate provider information and the impact of missing or incorrect identifiers on the revenue cycle.
2. Utilizing electronic health record (EHR) systems that automatically populate provider identifiers based on the attending provider selected for the service.
3. Establishing a pre-claim submission review process where claims are audited for completeness and accuracy of provider information.
4. Integrating real-time eligibility verification tools that flag missing or invalid provider identifiers before claim submission.
5. Keeping an updated database of provider identifiers, such as National Provider Identifiers (NPIs), and regularly cross-referencing this information with claims data.
6. Setting up alerts or prompts within the billing software to remind billers to check for the attending provider's primary identifier before finalizing the claim.
7. Regularly communicating with providers to ensure they understand the necessity of providing their accurate identifier for billing purposes.
By incorporating these strategies, healthcare providers can reduce the likelihood of receiving code N253 and improve the efficiency of their revenue cycle management.
The steps to address code N253 involve verifying and updating the attending provider's information. First, review the claim to ensure that the attending provider's National Provider Identifier (NPI) is present and correctly entered. If the NPI is missing, obtain it from the provider's office or through the National Plan & Provider Enumeration System (NPPES) and add it to the claim. If the NPI is incorrect, correct the information and resubmit the claim. Additionally, check for any other required identifiers or credentials that may be missing or incomplete, such as state license numbers or taxonomy codes, and update the claim accordingly. Once all provider information is validated and complete, resubmit the claim to the payer for processing. It's also advisable to implement a system of pre-claim checks to prevent similar issues in future submissions.