Denial code N574

Remark code N574 indicates the provider's type/specialty cannot order/refer. Verify claim info or contact the provider for accuracy.

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What is Denial Code N574

Remark code N574 is an indication that the claim has been flagged because the provider who ordered or referred the service does not match the types or specialties authorized to do so according to the payer's records. It suggests that there might be an error in the information submitted regarding the ordering/referring provider. To resolve this, it's recommended to double-check the accuracy of the provider details on the claim or to reach out to the ordering/referring provider for clarification.

Common Causes of RARC N574

Common causes of code N574 are:

1. Incorrect provider information entered on the claim, such as a mismatch between the provider's name and their National Provider Identifier (NPI).

2. The ordering or referring provider's specialty does not align with the services or products being ordered or referred, as per payer guidelines.

3. The provider's credentials or specialty information is outdated or incorrectly recorded in the payer's system.

4. The claim was submitted with an ordering or referring provider who is not recognized by the payer due to lack of enrollment or credentialing with the payer.

5. Data entry errors, such as typographical mistakes in the provider's information, leading to a mismatch in the payer's records.

Ways to Mitigate Denial Code N574

Ways to mitigate code N574 include ensuring that the ordering or referring provider's National Provider Identifier (NPI) and specialty are correctly listed and match the services or items being ordered or referred. Regularly updating and verifying the accuracy of provider databases within your billing system can prevent mismatches. Additionally, implementing a pre-claim verification process where the eligibility of providers to order or refer specific services is checked against current regulations and payer requirements can help avoid this issue. Training staff to recognize and rectify discrepancies in provider information before claims submission is also crucial.

How to Address Denial Code N574

The steps to address code N574 involve a multi-faceted approach to ensure the accuracy and compliance of the ordering/referring provider information on the claim. Initially, conduct a thorough review of the claim to confirm that the provider's information, including their National Provider Identifier (NPI), name, and specialty, is correctly entered and matches the information on file. If discrepancies are found, correct the information and resubmit the claim.

If the provider's information is accurate, the next step is to verify the provider's eligibility to order or refer services for Medicare or other insurance plans. This can be done by checking the provider's credentials and specialty against the insurer's requirements for ordering or referring providers. In some cases, it may be necessary to contact the provider to confirm their current credentials and specialty, or to request additional documentation that supports their eligibility to order or refer the specified service.

Should the provider's eligibility to order or refer be confirmed, but the claim still gets rejected with code N574, it may be necessary to contact the insurer directly. This contact should aim to clarify the reasons behind the rejection and to discuss the provider's qualifications and the documentation supporting their eligibility. It's crucial to have all relevant information and documentation on hand during this communication to facilitate a resolution.

In situations where the ordering/referring provider is indeed not eligible to order or refer the service in question, it will be necessary to identify an alternative provider who is eligible. This may involve coordinating with the patient's primary care provider or specialist to obtain a new referral or order that meets the insurer's requirements.

Throughout this process, maintain detailed records of all steps taken to address code N574, including communications with providers and insurers. This documentation can be invaluable for future reference and for supporting any necessary appeals or further discussions with insurers to resolve the issue and ensure the claim is paid.

CARCs Associated to RARC N574

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