Remark code N55 indicates that the claim submitted did not adhere to the established billing procedures regarding group, referring, or performing providers. This typically means that there may have been an error or omission related to the identification or documentation of the providers involved in the patient's care. The billing party may need to review and correct the claim according to the payer's guidelines for including provider information before resubmission.
Common causes of code N55 are:
1. Incorrect or missing provider identification numbers, such as National Provider Identifier (NPI) for the billing, referring, or performing providers.
2. Failure to include the necessary group practice information when a service is billed under a group NPI.
3. Inaccurate linkage between the performing provider and the billing provider on the claim form.
4. Omission of the referring provider's information when required for certain services or procedures.
5. Submission of claims with mismatched provider details, such as a performing provider listed who is not associated with the billing provider or group.
6. Lack of proper credentials or authorization for the performing provider associated with the services billed.
7. Non-compliance with payer-specific billing requirements for services rendered by multiple providers.
8. Use of outdated or incorrect provider information due to changes in practice, such as a provider leaving a group or changes in group affiliations.
Ways to mitigate code N55 include ensuring that all claims submitted include accurate and complete information about the group, referring, and performing providers. This involves verifying that the National Provider Identifier (NPI) for each provider is correct and that their roles are clearly defined and appropriately linked to the services billed. Regular training for billing staff on the correct procedures for assigning provider information on claims can help prevent this issue. Additionally, implementing a robust claim scrubbing process that checks for provider information accuracy before submission can reduce the likelihood of receiving an N55 code. It's also beneficial to stay updated on any changes in billing procedures that might affect how provider information should be reported.
The steps to address code N55 involve reviewing the claim to ensure that all provider information is correctly documented. First, verify that the group, referring, and performing provider details are accurate and complete, including their National Provider Identifier (NPI) numbers. If any discrepancies are found, correct the information and resubmit the claim. Additionally, check that the appropriate linkage between the providers and the services rendered is clearly indicated as per payer-specific billing guidelines. If the claim was denied due to a lack of required documentation, gather the necessary supporting information and include it with the corrected claim. It may also be beneficial to review the billing procedures with your billing staff to prevent future occurrences of this error.