Remark code N91 indicates that the services in question were not considered during the appeal review process. This means that when an appeal was submitted for a claim, the services associated with this remark code were not evaluated for coverage or payment decisions as part of that appeal. It may suggest that additional information or a separate appeal may be necessary to address these specific services.
Common causes of code N91 are:
1. The services in question were not originally included in the appeal documentation submitted.
2. The appeal was processed based on a specific set of services, and the services associated with this code were not part of that set.
3. There may have been an administrative oversight where the services were inadvertently left out of the appeal review process.
4. The services may have been added to the claim after the appeal was already submitted and thus were not considered during the review.
5. The provider may have failed to provide sufficient justification or medical necessity documentation for the services, leading to their exclusion from the appeal review.
6. The payer's appeal process may have specific guidelines on what services can be reviewed, and the services tied to this code did not meet those criteria.
Ways to mitigate code N91 include ensuring that all services in question are clearly documented and included in the initial appeal submission. It's important to review the appeal guidelines to understand which services are eligible for review and to provide comprehensive supporting information for each service being appealed. Regular training for coding and billing staff on appeal processes can help prevent omissions. Additionally, implementing a robust pre-appeal review process that includes a checklist of services and corresponding documentation can help ensure that no services are inadvertently left out of the appeal review.
The steps to address code N91 involve first verifying the accuracy of the claim and the appeal submission. Ensure that the services in question were indeed part of the original claim and that they were correctly coded and documented. If the services were omitted in error, resubmit the claim with the correct information and include a detailed cover letter explaining the oversight. If the appeal was submitted without including these services, prepare a new appeal that specifically addresses the services in question, providing all necessary documentation and a clear argument for coverage. It may also be beneficial to contact the payer directly to clarify the reason for the exclusion and to discuss the best way to proceed with the appeal for these services.