Remark code N275 indicates that the claim has been flagged because it lacks a complete and valid identifier for the provider of a purchased service from another payer. This means that the necessary information to identify the healthcare provider who delivered the service, which another insurer is responsible for covering, is either missing, incomplete, or incorrect on the submitted claim. To resolve this issue, the healthcare provider must provide the correct identifier for the claim to be processed.
Common causes of code N275 are:
1. The secondary or tertiary payer's claim form lacks the necessary provider identifier for a service that was purchased from another provider.
2. The submitted claim form contains an incorrect provider identifier that does not match the records of the other payer for the purchased service.
3. The provider identifier for the purchased service is incomplete, possibly missing required digits or components that are essential for claim processing.
4. The claim was submitted without the necessary qualifier to indicate the type of provider identifier being used, leading to confusion or rejection by the other payer.
5. There is a discrepancy between the provider information on file with the primary insurer and the information submitted to the other payer, causing a mismatch in the purchased service provider identifier.
6. The claim form has been filled out with outdated or retired provider identifiers that are no longer recognized by the other payer's system.
Ways to mitigate code N275 include implementing a robust verification process for all claims submissions to ensure that the other payer's purchased service provider identifier is present, complete, and accurate. This can be achieved by:
1. Training staff on the importance of collecting and verifying all necessary provider identifiers at the point of service.
2. Utilizing electronic health record (EHR) systems that prompt for required fields, including the other payer's provider identifier, before allowing a claim to be finalized.
3. Establishing a double-check system where a second set of eyes reviews claims, specifically looking for common errors such as missing or invalid identifiers.
4. Keeping up-to-date with payer requirements and ensuring that all billing software is configured to include prompts for the latest necessary identifiers.
5. Regularly auditing claims before submission to identify patterns of errors and address them through staff education or process improvements.
6. Engaging in proactive communication with other payers to understand their unique identifier requirements and ensure compliance.
7. Implementing automated claim scrubbing tools that can catch and flag claims with missing or incomplete information, including provider identifiers, before they are submitted.
The steps to address code N275 involve a thorough review of the claim to identify any missing, incomplete, or invalid identifiers for the other payer's purchased service provider. Begin by cross-referencing the claim with the patient's insurance information to ensure that the correct provider identifier, such as an NPI (National Provider Identifier), is included and accurately formatted. If the identifier is missing, obtain the correct information from the provider's administrative records or by contacting the provider directly. If the identifier is incomplete or invalid, verify the correct information through the appropriate channels, such as the payer's provider directory or the National Plan & Provider Enumeration System (NPPES). Once the correct identifier is confirmed, update the claim with the accurate information and resubmit it to the payer for processing. It's also advisable to review internal processes to prevent similar issues in future claims submissions.