Remark code N45 indicates that the payment made corresponds to the amount that was pre-authorized by the payer. This means that the reimbursement for the service or procedure provided has been adjusted to align with the previously agreed-upon amount authorized by the insurance company or payer.
Common causes of code N45 are discrepancies between the charged amount and the authorized amount for a service or procedure, incorrect input of the authorized amount into the billing system, or a mismatch between the payer's allowed amount and the provider's charge due to contract variations or updates. Additionally, this code may arise if there is a lack of proper authorization for services rendered, leading to adjustments based on the amount the payer authorizes for payment.
Ways to mitigate code N45 include ensuring that the billing team is up-to-date with the latest fee schedules and contracts negotiated with payers. Regularly reviewing and comparing the charges submitted with the authorized amounts can help identify discrepancies before claims are submitted. It's also important to have a robust charge capture process in place to ensure that all services provided are billed accurately according to the payer's authorization. Training staff to understand the authorization requirements and maintaining clear communication with payers about the scope of authorized services can also help prevent this code from appearing on remittance advice. Additionally, implementing a system to track authorization numbers and expiration dates can help ensure that claims are submitted within the authorized time frame and for the correct services.
The steps to address code N45 involve reviewing the payment against the authorized amount on file. First, verify the accuracy of the authorization by checking the dates of service, procedure codes, and provider information to ensure they match the services rendered. If there is a discrepancy, reach out to the payer to reconcile the difference and request an adjustment if necessary. If the payment is correct but less than expected, review the contract terms with the payer to understand the fee schedule and ensure that the authorized amount aligns with the negotiated rates. Document all communications with the payer for future reference and to support any appeals or additional claims. If the payment is accurate and no further action is needed, adjust the patient's account accordingly to reflect the correct balance.