Remark code N58 indicates that the claim has been processed with an issue related to the patient liability amount. Specifically, it means that the patient liability amount is either missing, incomplete, or invalid. This could imply that the information necessary to determine the patient's responsibility, such as copayment, coinsurance, or deductible, was not provided or was incorrect on the claim submission. As a result, the healthcare provider needs to review and correct the patient liability information before resubmitting the claim for proper adjudication.
Common causes of code N58 are:
1. The claim form submitted to the insurance company lacks the necessary information regarding the patient's financial responsibility, such as copayments, coinsurance, or deductibles.
2. The patient liability amount entered on the claim is incorrect or does not match the insurer's records or policy requirements.
3. The claim was processed without the patient liability amount due to an oversight or error during the billing process.
4. The patient's coverage details were not verified accurately before submitting the claim, leading to an incomplete assessment of the patient's liability.
5. There is a discrepancy between the billed charges and the insurance plan's benefits, causing confusion about the correct patient liability amount.
6. The electronic claim submission may have formatting errors or incorrect coding that resulted in the patient liability amount being omitted or rejected.
7. The insurance payer's system may have technical issues or updates that prevented the patient liability amount from being captured or transmitted correctly.
Ways to mitigate code N58 include implementing a robust patient information verification process at the point of service. Ensure that your front-end staff is thoroughly trained to collect and confirm all necessary patient demographic and insurance information. Utilize electronic eligibility verification tools to check patient coverage details in real-time, and make it a standard practice to update patient records during each visit. Additionally, integrate your electronic health record (EHR) system with your billing software to automatically flag any missing or incomplete patient liability amounts before claims submission. Regularly audit your claims before they are sent to the payer to catch any errors or omissions related to patient liability amounts. Establishing clear communication channels with patients to educate them about their financial responsibilities can also help in obtaining accurate liability information upfront.
The steps to address code N58 involve a thorough review of the patient's account to ensure that the patient liability amount is accurately documented. Begin by cross-referencing the Explanation of Benefits (EOB) or Electronic Remittance Advice (ERA) with the patient's insurance policy details to verify the correct copay, coinsurance, and deductible amounts. If discrepancies are found, update the patient's account with the correct liability amount.
Next, if the patient liability amount is missing, calculate the amount based on the insurance contract terms and the services provided. Ensure that any contractual adjustments have been applied correctly before determining the patient's responsibility.
If the patient liability amount is incomplete or invalid, identify the specific error or omission. This could involve rechecking the service codes billed against the insurance plan's coverage benefits or recalculating the patient's share after accounting for prior payments or adjustments.
Once the correct patient liability amount is established, update the billing system and resubmit the claim with the revised information. It's also important to communicate any changes to the patient, providing a clear explanation of their financial responsibility and any impact on their bill.
To prevent future occurrences of code N58, implement a process for double-checking patient liability amounts before initial claim submission and educate billing staff on the importance of accurate data entry regarding patient financial responsibility.