DENIAL CODES

Denial code N567

Remark code N567 is an explanation for services not covered due to their preventative nature.

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What is Denial Code N567

Remark code N567 indicates that the service or item billed is not covered by the payer because it is considered preventative care.

Common Causes of RARC N567

Common causes of code N567 are services or procedures billed that are classified under the insurer's policy as preventive care, but the patient's plan does not cover preventive services, or the services were not coded correctly to reflect their preventive nature. Additionally, this code may be used if the services exceed the frequency limits for preventive care as outlined in the patient's health insurance policy.

Ways to Mitigate Denial Code N567

Ways to mitigate code N567 include ensuring that billing staff are thoroughly trained in distinguishing between preventative and diagnostic codes based on the patient's medical records and the provider's notes. Implementing a pre-claim review process where codes are double-checked for their alignment with the specific treatment or service provided can also help. Regularly updating coding practices in accordance with the latest coding guidelines and having a robust query process for clinicians to clarify the intent of services can prevent this issue. Additionally, utilizing advanced coding software that flags potential preventative service codes for review before submission can reduce the occurrence of N567.

How to Address Denial Code N567

The steps to address code N567 involve first reviewing the patient's medical records and the services provided to ensure that the coding accurately reflects the nature of the service. If the service was indeed therapeutic rather than preventative, re-code the service appropriately and resubmit the claim with a detailed explanation or documentation supporting the therapeutic nature of the service. If the service was preventative and not covered under the patient's plan, consider informing the patient about the denial and their responsibility for payment. Additionally, explore if there are alternative billing codes that accurately describe the service and are covered under the patient's insurance plan. Lastly, it may be beneficial to check if there are any exceptions in the patient's policy that could allow for coverage of the preventative service and submit an appeal if applicable.

CARCs Associated to RARC N567

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