DENIAL CODES

Denial code N272

Remark code N272 indicates an issue with a secondary payer's attending provider identifier, such as missing or invalid details.

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What is Denial Code N272

Remark code N272 indicates that the claim has been flagged because it lacks a complete and valid identifier for the attending provider from another payer. This means that the information necessary to identify the healthcare professional who provided the care, as recognized by the secondary or tertiary insurer, is either missing, incomplete, or incorrect on the submitted claim. To resolve this issue, the healthcare provider must provide the correct attending provider identifier as per the other payer's requirements and resubmit the claim for processing.

Common Causes of RARC N272

Common causes of code N272 are:

1. The attending provider's National Provider Identifier (NPI) is not included on the claim submitted to the secondary or tertiary payer.

2. The attending provider's information is incomplete, such as a missing first or last name, or the information provided does not match the records of the other payer.

3. Incorrect or outdated provider identifiers are used, possibly due to changes in provider information that have not been updated with the payer.

4. The claim form is missing required fields or sections that identify the attending provider for the other payer.

5. Data entry errors, such as typos or transposed numbers in the attending provider's identifier, lead to the payer being unable to validate the provider's identity.

6. The claim was submitted without the necessary linkage between the attending provider and the service provided, as required by the other payer's policies.

7. Electronic claim submission issues, where the electronic data interchange (EDI) system may have truncated or incorrectly formatted the provider identifier information.

8. The provider's identifier is not recognized by the other payer due to the provider not being enrolled or credentialed with that payer.

Ways to Mitigate Denial Code N272

Ways to mitigate code N272 include implementing a robust verification process to ensure that all claims submitted to secondary payers include the correct attending provider identifier. This can be achieved by:

1. Training staff on the importance of capturing accurate provider information during the patient intake process.
2. Utilizing electronic health record (EHR) systems that prompt for the attending provider identifier when entering data for secondary insurance claims.
3. Conducting regular audits of claims to identify and correct any patterns of missing or incorrect provider identifiers before submission.
4. Establishing a checklist for billing personnel to verify that all necessary provider identifiers are present and valid on claims.
5. Integrating real-time eligibility and benefits verification tools that flag missing or invalid provider identifiers at the point of service.
6. Collaborating with attending providers to ensure they understand the importance of providing their identifier for secondary payer claims.
7. Updating your practice management system to automatically cross-reference provider identifiers against a database of valid identifiers for secondary payers.

How to Address Denial Code N272

The steps to address code N272 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 accurately entered. If the NPI is missing, obtain the correct NPI from the provider's office or from the National Plan and Provider Enumeration System (NPPES) registry. If the NPI is incorrect, correct the information on the claim. Once the NPI is validated or corrected, resubmit the claim to the payer. Additionally, check if there are any specific requirements for the other payer that may need to be included on the claim, such as a taxonomy code or state license number, and update the claim accordingly before resubmission. It's also important to ensure that the attending provider is properly linked to the service billed and that their information matches what is on file with the other payer to prevent future denials.

CARCs Associated to RARC N272

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