Denial code N513

Remark code N513 is an alert for the first remittance of a non-NCPDP claim initially submitted in real-time, now with adjudication changes.

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What is Denial Code N513

Remark code N513 is an alert indicating that this is the first remittance advice for a non-NCPDP (National Council for Prescription Drug Programs) claim that was initially submitted in real-time but has since undergone a change in its adjudication process.

Common Causes of RARC N513

Common causes of code N513 are incorrect initial real-time submission details, adjustments made to the claim post-real-time submission, and discrepancies between the original claim information and the final adjudicated details.

Ways to Mitigate Denial Code N513

Ways to mitigate code N513 include implementing a robust pre-submission review process to ensure that all claim details are accurate and complete before the initial real-time submission. This involves double-checking the patient's information, diagnosis codes, and service codes for accuracy. Additionally, investing in claim scrubbing software can help identify and correct errors or inconsistencies that could lead to a change in adjudication. Training staff on the specific requirements for NCPDP claims and regularly updating them on any changes in submission guidelines can also reduce the likelihood of this issue. Finally, establishing a direct line of communication with payers can facilitate quicker resolution and clarification on adjudication changes, preventing similar issues in future submissions.

How to Address Denial Code N513

The steps to address code N513 involve a detailed review and comparison of the initial real-time submission with the remitted claim to identify any changes in adjudication. Begin by documenting the specific alterations in the adjudication process that have been highlighted by this remark code. Next, verify the accuracy of the changes, ensuring that they align with the services provided and the billing practices of your healthcare facility. If discrepancies are found, prepare and submit a detailed explanation or correction claim, including any necessary documentation to support the original billing or to justify the adjustments made. It's also advisable to update your billing system or records to reflect the adjudication changes for future reference and to prevent similar issues. Lastly, monitor the response to your submission closely to ensure that the issue is resolved promptly and to maintain the revenue cycle's integrity.

CARCs Associated to RARC N513

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