DENIAL CODES

Denial code N697

Remark code N697 is an alert indicating a reversal due to adjustments from a payer's retroactive contract incentive program.

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What is Denial Code N697

Remark code N697 indicates: Alert: This reversal is due to a payer's retroactive contract incentive program adjustment.

Common Causes of RARC N697

Common causes of code N697 are adjustments made by the payer due to changes or updates in their contract incentive programs that have retroactive effects on previously processed claims. This can include updates to fee schedules, performance-based payment adjustments, or corrections to previously applied incentive payments that were not calculated correctly according to the terms of the payer's contract at the time of service.

Ways to Mitigate Denial Code N697

Ways to mitigate code N697 include implementing a robust tracking and monitoring system for all payer contracts and their respective amendments or incentive programs. Regularly updating billing and coding teams on any changes in payer contracts can ensure that claims are submitted correctly the first time. Additionally, establishing a direct line of communication with payers to receive timely updates on any retroactive adjustments or incentive programs can help in adjusting billing processes accordingly. Conducting periodic audits on claims affected by retroactive adjustments can also identify patterns or common issues, allowing for preemptive corrections in future submissions. Lastly, leveraging technology to automate the identification and application of contract incentives can reduce the risk of errors leading to this specific reversal code.

How to Address Denial Code N697

The steps to address code N697 involve a multi-faceted approach focusing on understanding the specifics of the payer's retroactive contract incentive program and its impact on the claim. Initially, it's crucial to review the contract agreement with the payer to identify the criteria and conditions under which such adjustments are applied. This understanding will guide the next steps and help in identifying any discrepancies or errors in the adjustment.

Next, gather all relevant claim documentation and any previous correspondence with the payer regarding the incentive program. This documentation will be essential for any discussions or disputes with the payer.

Following this, contact the payer's representative to discuss the adjustment. The goal of this conversation is to gain a clear understanding of why the adjustment was made and to verify that it was applied correctly according to the contract terms. If the adjustment was made in error, provide the payer with the necessary documentation to support the claim for reversal of the adjustment.

If the adjustment is valid, assess the impact on the revenue cycle and determine if there are steps that can be taken to mitigate such adjustments in the future. This might involve adjusting billing practices or renegotiating certain terms of the contract.

Lastly, update the billing system to reflect the adjustment and document all communications and outcomes related to the adjustment for future reference. This will help in managing similar situations more efficiently in the future and could provide valuable insights when negotiating future contracts with payers.

CARCs Associated to RARC N697

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