Denial code N455

Remark code N455 is an alert indicating a claim was denied due to a missing physician order, requiring submission for processing.

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What is Denial Code N455

Remark code N455 indicates that the claim has been processed but cannot be paid as it stands because it lacks a necessary physician order. This means that for the claim to be considered complete and eligible for payment, documentation of an order from a physician directing the specific service or procedure billed must be provided.

Common Causes of RARC N455

Common causes of code N455 (Missing Physician Order) are incomplete documentation at the time of billing, failure to obtain or record the physician's order prior to service delivery, clerical errors in patient files, and miscommunication between healthcare providers and administrative staff.

Ways to Mitigate Denial Code N455

Ways to mitigate code N455 include implementing a comprehensive check system before claim submission to ensure all required physician orders are attached. Utilizing electronic health records (EHR) effectively can automate the inclusion of necessary documentation. Training staff on the importance of complete documentation and conducting regular audits can also help identify and rectify any lapses in the process. Establishing a clear communication channel between billing specialists and healthcare providers can facilitate the quick resolution of any missing information. Additionally, adopting a proactive approach by creating a checklist for common documentation requirements for different services can prevent this issue from occurring.

How to Address Denial Code N455

The steps to address code N455 involve a multi-faceted approach to ensure the required physician order is obtained and correctly attached to the patient's billing record. Initially, contact the department or healthcare professional responsible for the patient's care to request the missing physician order. If the order is available but was not previously attached, ensure it is properly documented in the patient's electronic health record (EHR) and resubmit the claim with the necessary documentation attached.

In cases where the physician order cannot be immediately located, it may be necessary to reach out directly to the physician or ordering provider to obtain a new or duplicate order. Ensure that all communication with healthcare providers regarding missing documentation is documented, including the date of request and the name of the individual contacted.

Once the physician order is received, review it for completeness and accuracy, ensuring it meets all required criteria for the specific service or procedure billed. This includes verifying the patient's name, date of service, detailed description of the service or procedure, and the physician's signature.

After the order is deemed complete, update the patient's billing record with the newly obtained physician order. Resubmit the claim to the payer with the appropriate documentation attached, ensuring that all other aspects of the claim are accurate and meet payer requirements.

Finally, consider implementing a system of checks and balances within your billing process to prevent similar issues from occurring in the future. This could involve a pre-claim review process to ensure all necessary documentation, including physician orders, is attached before claims are submitted. Regular training for staff on documentation requirements can also help reduce the occurrence of code N455 and improve the overall efficiency of your billing process.

CARCs Associated to RARC N455

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