Remark code N264 indicates that the claim submitted lacks a valid name for the ordering provider, or the information provided is either incomplete or incorrect. This requires attention to ensure that the ordering provider's details are accurately captured and resubmitted for the claim to be processed.
Common causes of code N264 are:
1. The ordering provider's name was not included on the claim submission.
2. The provider's name was entered incorrectly, with typos or misspellings.
3. The claim form used an outdated or incorrect provider identifier.
4. The provider's information was incomplete, lacking necessary credentials or suffixes.
5. The electronic claim submission omitted the provider's name due to a technical error or software issue.
6. The claim was submitted with an invalid National Provider Identifier (NPI) for the ordering provider.
7. The ordering provider's name does not match the NPI registered in the payer's system.
8. The claim lacks the required ordering provider information as per the payer's specific documentation requirements.
Ways to mitigate code N264 include implementing a thorough review process to ensure that the ordering provider's name is accurately and completely captured on all claims before submission. This can be achieved by:
1. Training staff on the importance of entering the full name of the ordering provider as it appears on their National Provider Identifier (NPI) registration.
2. Utilizing electronic health record (EHR) systems that prompt for the ordering provider's information and verify its completeness before allowing the claim to proceed.
3. Establishing a double-check system where a second set of eyes reviews claims, specifically looking for provider information accuracy.
4. Integrating real-time eligibility verification tools that flag missing or incorrect provider details during the patient check-in process.
5. Regularly auditing claims to identify and address any recurring issues with provider information entry.
6. Creating a standardized process for collecting and updating provider information in the practice management system to ensure it remains current and valid.
The steps to address code N264 involve verifying the ordering provider's information on the claim. First, review the patient's medical records and the original order to ensure the provider's name is correctly documented. Next, update the claim with the correct provider name, ensuring that it matches the name on file with the National Provider Identifier (NPI) registry. If the provider's name has changed due to marriage, divorce, or other reasons, confirm that the NPI registry has been updated to reflect this change. Once the correct information is in place, resubmit the claim to the payer. To prevent future occurrences, implement a verification process that checks the ordering provider's information against the NPI registry before initial claim submission.