Remark code N78 indicates that the claim has been processed but cannot be paid because the necessary components of the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) service, also known as the child and teen checkup, were not completed as required. This implies that for the claim to be considered for payment, the provider must ensure that all mandatory EPSDT components are completed and documented according to the program's guidelines.
Common causes of code N78 are incomplete documentation of the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services, failure to perform one or more required components of the EPSDT checkup, such as vision, hearing, or dental screenings, or missing immunizations. Additionally, this code may be used if the provider did not follow state-specific EPSDT guidelines or if the claim was not properly coded to indicate that all components of the checkup were completed.
Ways to mitigate code N78 include implementing a comprehensive checklist for the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services to ensure all required components are completed during the visit. Staff training should emphasize the importance of adhering to EPSDT guidelines and performing all necessary screenings, assessments, and interventions as mandated for the child and teen checkup. Regular audits of patient records can help identify any missed components so that corrective actions can be taken promptly. Additionally, utilizing electronic health record (EHR) systems with built-in reminders and prompts can assist providers in completing all necessary EPSDT components during the patient's appointment.
The steps to address code N78 involve reviewing the documentation for the child and teen checkup (Early and Periodic Screening, Diagnostic, and Treatment - EPSDT) to ensure that all required components were indeed completed and properly recorded. If any components were missed, schedule the patient for a follow-up appointment to complete the necessary elements of the checkup. After ensuring that all components have been addressed, resubmit the claim with the updated information and comprehensive documentation to support the services provided. If the claim was correctly submitted with all components initially, gather the supporting documentation and submit an appeal to the payer, including a detailed cover letter explaining the oversight and providing evidence that the EPSDT was fully completed as required.