Remark code N89 indicates that while payment details for the claim have been sent to multiple secondary payers, due to format restrictions, only one of those secondary payers can be identified in the current remittance advice document.
Common causes of code N89 are situations where a claim has been processed and payment details need to be communicated to multiple secondary payers, but due to the limitations of the remittance advice format, only one secondary payer's information can be included. This may occur in cases where there are coordination of benefits issues, or when a patient has multiple insurance policies and the primary payer has forwarded the claim details to all subsequent payers, but the electronic format restricts the reporting to a single secondary payer on the remittance advice. It could also be a result of the primary payer's system constraints or a limitation in the electronic data interchange (EDI) standards that are being used for the claim transmission.
Ways to mitigate code N89 include implementing a robust claim tracking system that allows for the monitoring of multiple payer submissions. Ensure that your billing software can handle and report on claims sent to more than one secondary payer. Train your billing staff to accurately record and reconcile payment information from all payers, and to manually track any additional secondary payers that cannot be automatically identified in the remittance advice. Regularly review and update payer information to ensure that all necessary details are captured and clearly communicated in the claim submissions. Establish a clear communication channel with secondary payers to verify receipt and processing of claims, and to confirm which payer should be listed on the remittance advice when limitations prevent showing more than one.
The steps to address code N89 involve a multi-faceted approach to ensure proper payment allocation and claim tracking. First, review the Explanation of Benefits (EOB) or Electronic Remittance Advice (ERA) from the primary payer to determine which secondary payer has been identified. Next, contact any additional secondary payers that may have been involved with the claim to confirm if they have received the necessary payment information. If they have not, manually forward the primary payer's EOB or ERA along with the claim to the unidentified secondary payer(s).
Ensure that your billing system or practice management software accurately reflects the transfer of information to multiple payers. This may involve entering notes or updating the claim status to indicate that the claim information has been sent to more than one secondary payer. Monitor the claim status with each secondary payer to verify that they have processed the claim and issued payment or a denial. If payment is received, post it to the patient's account accordingly. If a denial is issued, assess the reason and take appropriate corrective action, which may include appealing the decision or correcting claim errors.
Finally, reconcile all payments and adjustments from primary and secondary payers to ensure the claim is fully resolved. If there is an outstanding balance, determine if it is patient responsibility or if there is another tertiary payer to bill. Keep detailed records of all communications and transactions related to the claim to facilitate any future inquiries or audits.