DENIAL CODES

Denial code N604

Remark code N604 is an explanation for a base fee adjustment in NY, calculated as per Regulation 68, following the NY Workers' Compensation Board Schedule.

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What is Denial Code N604

Remark code N604 indicates that the payment adjustment is made in accordance with New York No-Fault Law, Regulation 68. This means the base fee for the service provided was calculated based on the New York Workers' Compensation Board Schedule of Medical Fees, as outlined in Regulation 83 and/or Appendix 17-C of 11 NYCRR (New York Codes, Rules, and Regulations).

Common Causes of RARC N604

Common causes of code N604 are incorrect application of the New York Workers' Compensation Board Schedule of Medical Fees, misinterpretation of Regulation 83 or Appendix 17-C of 11 NYCRR, errors in calculating the base fee according to the specified regulations, or failure to adhere to the specific billing requirements outlined under the New York No-Fault Law, Regulation 68.

Ways to Mitigate Denial Code N604

Ways to mitigate code N604 include ensuring that billing staff are thoroughly trained on the specific requirements of the New York Workers' Compensation Board Schedule of Medical Fees. This includes familiarization with Regulation 83 and Appendix 17-C of 11 NYCRR to ensure that claims are submitted with the correct base fee calculations. Regular audits of claims should be conducted to identify and correct any discrepancies in fee calculations before submission. Additionally, implementing a robust software solution that automatically updates fee schedules and regulations can help prevent errors related to outdated information. Engaging in continuous education about changes in the New York No-Fault Law and its regulations will also aid in preventing this code from occurring.

How to Address Denial Code N604

The steps to address code N604 involve a multi-faceted approach to ensure compliance and proper billing under the specific regulations mentioned. Firstly, review the current charge against the New York Workers' Compensation Board Schedule of Medical Fees to verify accuracy. If discrepancies are found, adjust the billing amount accordingly. Secondly, ensure that all documentation supporting the medical service provided is comprehensive and aligns with the requirements of Regulation 83 and Appendix 17-C of 11 NYCRR. This includes detailed medical records, service dates, and any applicable justifications for the services rendered. Thirdly, if the initial claim was reduced or denied based on this code, re-submit the claim with the adjusted charge (if necessary) and include a cover letter highlighting the compliance with the mentioned regulations and appendices, along with any additional supporting documentation that strengthens the claim. Lastly, consider engaging in a dialogue with the payer to discuss the specifics of the claim adjustment or denial, providing an opportunity to clarify any misunderstandings or to receive further guidance on how to ensure compliance with New York No-Fault Law and related regulations in future submissions.

CARCs Associated to RARC N604

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