DENIAL CODES

Denial code N522

Remark code N522 is an alert that a claim is a duplicate of one already processed or pending as a crossover claim.

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What is Denial Code N522

Remark code N522 indicates that the claim submitted has been identified as a duplicate of another claim that has already been processed or is scheduled to be processed as a crossover claim.

Common Causes of RARC N522

Common causes of code N522 are:

1. Submitting the same claim to the primary insurer more than once, either due to manual errors or electronic submission glitches.

2. The primary insurer has already processed the claim and forwarded it to the secondary insurer, but the provider also submits a duplicate claim to the secondary insurer.

3. Miscommunication or lack of coordination between billing departments, leading to the unintentional resubmission of the claim.

4. Incorrectly assuming that the initial claim was lost or rejected without proper verification, resulting in a duplicate submission.

5. Failure to update billing records to reflect that a claim has already been processed or is in the process of being crossed over to another payer.

Ways to Mitigate Denial Code N522

Ways to mitigate code N522 include implementing a robust claim tracking system that flags potential duplicates before submission. Regularly training staff on the importance of verifying if a claim has already been submitted or is scheduled for crossover processing can also reduce occurrences. Additionally, integrating a pre-submission verification step into your RCM software to check for duplicates based on patient ID, service date, and provider can help prevent this issue. Establishing a clear communication channel with payers to quickly resolve any ambiguities regarding claim status can further minimize the risk of receiving code N522.

How to Address Denial Code N522

The steps to address code N522 involve a multi-faceted approach to ensure the claim is processed correctly without unnecessary delays. Initially, verify the claim's status in your billing system to confirm if it has indeed been submitted previously. If the claim has been duplicated in error, document the mistake and adjust your records accordingly to prevent future occurrences.

Next, communicate with the payer to understand their process for handling crossover claims and to confirm if the original claim is being processed as intended. This may involve providing additional information or clarification to facilitate the crossover claim's processing.

In parallel, review your internal processes for submitting crossover claims to identify any gaps or errors that could lead to duplicates. This might include auditing how claims are flagged as crossover in your system and ensuring that your billing team is adequately trained on the nuances of crossover claims submission.

If the duplicate submission was not an error on your part, and the claim has not been processed as a crossover claim as expected, gather all relevant documentation, including the original claim submission and any correspondence with the payer regarding the crossover process. Use this documentation to appeal the decision or to resubmit the claim with a clear explanation and evidence that supports its processing as a crossover claim.

Lastly, consider implementing a more robust tracking and follow-up system for crossover claims to monitor their status actively and address any issues proactively before they result in remark codes like N522. This could involve setting up alerts for when claims are not processed within a typical timeframe or establishing a dedicated team to handle the complexities of crossover claims.

CARCs Associated to RARC N522

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