Remark code N695 alerts that a reversal occurred due to wrong patient financial responsibility info initially adjudicated.
Remark code N695 indicates: Alert: This reversal is due to incorrect patient financial responsibility information on the initial adjudication.
Common causes of code N695 are:
1. Incorrect entry of patient insurance coverage details during the initial claim submission process.
2. Misinterpretation of the patient's insurance plan benefits, leading to inaccurate calculation of copays, deductibles, or coinsurance.
3. Failure to update patient financial responsibility information following changes in the patient's insurance coverage or policy terms.
4. Errors in the electronic data interchange (EDI) process that result in the transmission of outdated or incorrect patient financial information to the payer.
5. Lack of verification of the patient's current insurance information and benefits eligibility prior to claim submission.
6. Inaccurate coding of services that may affect the determination of patient versus insurer financial responsibility.
Ways to mitigate code N695 include implementing a robust verification process for patient insurance details at every visit. Ensure that your front desk staff is trained to update patient information in the system accurately and to double-check the financial responsibility details with the patient or their representative. Utilizing advanced software that can flag discrepancies in patient information or insurance details before submission can also help. Regularly auditing patient accounts for accuracy in financial responsibility assignments and conducting periodic training sessions for staff on the importance of precise data entry are also effective strategies. Engaging with patients to educate them about the importance of providing up-to-date insurance information can further reduce the occurrence of this code.
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The steps to address code N695 involve a thorough review and correction process of the patient's financial responsibility information. Initially, verify the accuracy of the patient demographic and insurance details entered into the system. Cross-check the patient's insurance card and any other documentation against what was initially submitted. If discrepancies are found, correct the information and resubmit the claim.
Next, analyze the Explanation of Benefits (EOB) from the initial adjudication to identify the specific financial responsibility error. This could involve incorrect copayment, coinsurance, deductible amounts, or other patient responsibility figures. Consult the payer's contract and the patient's current insurance benefits to confirm the correct amounts.
If the error stems from an internal misinterpretation of the insurance policy or benefits, provide additional training or clarification to the staff involved to prevent future occurrences.
After correcting the error, prepare and submit a detailed appeal to the insurance company, including a corrected claim if necessary, and any supporting documentation that justifies the adjustment of the patient's financial responsibility. Clearly outline the error found and the corrective action taken in your appeal letter.
Monitor the appeal status closely and maintain open communication lines with the payer. Be prepared to provide additional information or clarification as requested by the insurance company to expedite the resolution of the reversal.
Finally, update the patient's account with the corrected financial responsibility information and inform the patient of the correction and any impact it may have on their balance or future billing. Ensure that the patient understands the correction and provide clear information on any next steps they need to take.
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