DENIAL CODES

Denial code N773

Remark code N773 indicates that the drug was not purchased from a designated specialty vendor, impacting claim processing.

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What is Denial Code N773

Remark code N773 is an indication that the claim has been adjusted because the medication or drug supplied was not obtained from a designated specialty vendor as required by the payer's policy or the patient's health plan.

Common Causes of RARC N773

Common causes of code N773 are:

1. The medication was sourced from a non-preferred vendor not classified as a specialty pharmacy by the payer.

2. The healthcare provider did not verify the payer’s list of approved specialty vendors before obtaining the medication.

3. The claim was submitted with incorrect information, mistakenly indicating the drug was not sourced from an approved specialty vendor.

4. There was a lack of communication or misunderstanding between the healthcare provider and the pharmacy regarding the payer’s requirements for specialty medications.

5. The payer’s policies regarding specialty vendors have recently changed, and the healthcare provider was not aware of the update at the time of medication procurement.

Ways to Mitigate Denial Code N773

Ways to mitigate code N773 include implementing a robust verification process within your procurement system to ensure all drugs are sourced from approved specialty vendors. This can be achieved by maintaining an updated list of authorized vendors and cross-referencing each purchase against this list before finalizing transactions. Additionally, training staff on the importance of sourcing from these vendors and the potential financial implications of not doing so can help prevent this issue. Regular audits of procurement practices and vendor performance can also identify and rectify any deviations from established protocols, further reducing the likelihood of encountering code N773.

How to Address Denial Code N773

The steps to address code N773 involve a multi-faceted approach to ensure compliance with payer requirements and to streamline the procurement process for specialty drugs. Firstly, it's crucial to establish a clear communication channel with the prescribing physician to discuss the necessity of the prescribed drug and explore if there are alternative medications that meet the payer's criteria for specialty vendors. If the prescribed drug is indispensable, the next step is to coordinate with the pharmacy team to identify approved specialty vendors for the drug in question and arrange for its procurement through these channels for future prescriptions.

Simultaneously, for the claim at hand, gather all relevant documentation that supports the medical necessity of the drug and any attempts made to obtain it from an approved specialty vendor. This may include communication records with vendors who were unable to supply the drug, if applicable. Submit an appeal to the payer with this documentation, clearly explaining the situation and why the drug was obtained from a non-approved vendor, emphasizing the patient's immediate need and the efforts made to comply with the payer's policies.

To prevent future occurrences of code N773, it's advisable to conduct regular training sessions for the prescribing and pharmacy staff about the importance of adhering to payer requirements for specialty drugs and the list of approved vendors. Additionally, consider implementing a verification system within the electronic prescribing process that alerts the prescriber if the selected medication must be obtained from a specialty vendor, according to the patient's insurance policy. This proactive approach can significantly reduce the incidence of code N773 and streamline the procurement process for specialty medications.

CARCs Associated to RARC N773

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