DENIAL CODES

Denial code N687

Remark code N687 indicates a reversal of charges due to a patient's retroactive disenrollment from their insurance plan.

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What is Denial Code N687

Remark code N687 is an alert indicating that the reversal of the claim or transaction is due to a retroactive disenrollment of the patient from their insurance plan.

Common Causes of RARC N687

Common causes of code N687 are incorrect patient eligibility information at the time of service, changes in the patient's insurance coverage that were not updated or communicated in a timely manner, and administrative errors in processing the patient's insurance information leading to the assumption of active coverage when in fact the coverage had been terminated retroactively.

Ways to Mitigate Denial Code N687

Ways to mitigate code N687 include implementing a robust verification system to regularly check patients' insurance status, especially before submitting claims. Establishing a direct line of communication with insurance providers can also help in receiving timely updates about any changes in a patient's enrollment status. Additionally, training staff to recognize the signs of potential disenrollment and to act swiftly by verifying coverage can prevent this issue. Utilizing technology that automatically flags changes in insurance status can further reduce the risk of encountering this code. Lastly, maintaining accurate and up-to-date patient records ensures that any changes in insurance coverage are promptly reflected in the billing system, minimizing the chances of a reversal due to retroactive disenrollment.

How to Address Denial Code N687

The steps to address code N687 involve a multi-faceted approach to rectify the situation caused by a retroactive disenrollment. Initially, it's crucial to verify the patient's current insurance status and eligibility to ensure that any subsequent billing or claims submissions are directed to the correct payer. This may involve contacting the patient for updated insurance information or utilizing online verification tools provided by insurance companies.

Following the verification of insurance details, reprocess the claim with the correct payer information. If the claim was initially submitted to the wrong insurance due to the retroactive disenrollment, submitting it to the correct insurer is essential for reimbursement.

In cases where the patient does not have an alternative insurance coverage, or if the service provided is not covered by the new insurance plan, consider reaching out to the patient to discuss potential payment options. This could include setting up a payment plan or exploring eligibility for financial assistance programs.

Additionally, it's important to document the steps taken to address the issue in the patient's account. This documentation should include details of the retroactive disenrollment, any communication with insurance companies or the patient, and the outcome of reprocessed claims or payment arrangements. This documentation will be valuable for future reference and in ensuring compliance with billing and insurance regulations.

Lastly, review internal processes to identify any potential improvements that could minimize the impact of retroactive disenrollments in the future. This might involve enhancing eligibility verification processes or improving communication channels with patients regarding their insurance status. By taking proactive steps, healthcare providers can better manage similar situations and mitigate financial risks associated with retroactive disenrollments.

CARCs Associated to RARC N687

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