Remark code N273 indicates that the claim submitted is lacking a valid operating provider identifier for another payer involved, or the information provided is incomplete or incorrect. This typically means that the secondary or tertiary insurer's records do not match the operating provider's identifier details as submitted on the claim, which could lead to a delay or denial of payment. It is essential to review and correct the provider identifier information for the other payer to ensure proper claim adjudication.
Common causes of code N273 are:
1. The secondary or tertiary payer's claim form lacks the operating provider's National Provider Identifier (NPI).
2. The submitted claim form contains an incorrect NPI that does not match the operating provider's records.
3. The operating provider's NPI is not properly formatted or is incomplete on the claim submission.
4. The claim was submitted without the required operating provider information as mandated by the payer's guidelines.
5. The operating provider's identifier was omitted due to clerical error or oversight during the billing process.
6. The electronic claim file was corrupted or did not transmit the operating provider's NPI correctly.
7. The payer's system is unable to validate the operating provider's NPI against the National Plan and Provider Enumeration System (NPPES) database.
Ways to mitigate code N273 include implementing a thorough verification process for all claims to ensure that the operating provider's identifier is present, complete, and accurate. This can be achieved by:
1. Establishing a routine check within your billing software that flags any claims missing the operating provider's identifier before submission.
2. Training your billing staff to recognize and correct any discrepancies in provider identifiers during the claim preparation stage.
3. Creating a standardized process for collecting and recording provider identifiers at the point of service to prevent data entry errors.
4. Utilizing electronic health record (EHR) systems that automatically populate provider identifiers into claims based on the operating provider's information stored in the system.
5. Regularly updating your provider database to ensure that all identifiers are current and valid according to the National Provider Identifier (NPI) registry.
6. Conducting periodic audits of your claims to identify and address any recurring issues with provider identifier information.
7. Collaborating with other payers to understand their specific requirements for provider identifiers and adapting your processes accordingly.
The steps to address code N273 involve a multi-faceted approach to ensure that the claim is updated with the correct information and resubmitted promptly. Begin by reviewing the claim to identify the missing or incorrect operating provider identifier. Consult with the provider's administrative staff to obtain the correct operating provider National Provider Identifier (NPI) or other required identifier details. Once the correct information is secured, update the claim form accordingly.
Next, verify that the updated information matches the records of the other payer, if applicable, to prevent further discrepancies. It's also essential to check that all other related fields on the claim are accurate and complete to avoid additional errors.
After updating the claim, resubmit it to the payer as soon as possible. Keep a record of the changes made and monitor the claim to ensure it is processed correctly upon resubmission. Additionally, consider implementing a system to routinely verify provider identifiers before claim submission to minimize the occurrence of this issue in the future.