Remark code N34 indicates that the claim submitted by the healthcare provider used an incorrect form or format for the particular service billed. This means that the payer has identified an issue with how the claim was presented, which could be related to the type of form used (such as CMS-1500 or UB-04), the way information was entered on the form, or the electronic format if the claim was submitted electronically. The provider will need to review the claim to determine the appropriate form or format and resubmit the claim for processing.
Common causes of code N34 are:
1. Submission of an outdated version of the claim form, such as using a previous edition of the CMS-1500 or UB-04 form.
2. Failing to follow the specific formatting requirements, such as incorrect font size, typeface, or missing red ink for certain fields.
3. Using the wrong form type for the type of service or provider, such as a professional provider using an institutional claim form or vice versa.
4. Omitting required information or including incomplete data in the claim form fields.
5. Incorrect or missing plan-specific form locators or identifiers that are necessary for processing the claim.
6. Inclusion of non-standard abbreviations or symbols that are not recognized by the payer's claim processing system.
7. Failure to adhere to electronic claim submission standards, such as those outlined in the ASC X12 837 format, if the claim was submitted electronically.
8. Not following payer-specific guidelines for claim submission, which can vary from one insurance company to another.
Ways to mitigate code N34 include ensuring that the correct claim form is used for the type of service being billed. For instance, institutional providers should use the UB-04 form, while professional providers typically use the CMS-1500 form. It's also important to stay updated on any changes in form requirements by payers. Regular training for billing staff on proper form usage and conducting periodic audits of claim forms can help identify and correct any issues with form completion before submission. Implementing electronic health record (EHR) systems that have integrated billing functionalities can also reduce the likelihood of using an incorrect form, as these systems often have built-in checks for the type of service and corresponding correct claim form.
The steps to address code N34 involve a thorough review of the claim submission to identify the specific formatting or form errors. Begin by comparing the claim to the most current billing guidelines to ensure the correct form was used (e.g., CMS-1500 for professional services or UB-04 for institutional services). Next, check for common formatting issues such as incorrect or missing patient identifiers, provider information, dates of service, procedure codes, or diagnosis codes. Once the errors are pinpointed, correct them directly on the claim form. If the claim was submitted electronically, make the necessary adjustments in the practice management system or billing software, and resubmit the claim. Ensure that all fields are completed accurately and in accordance with payer-specific requirements. It may also be beneficial to review the payer's claim submission guidelines to prevent future occurrences of this error.