Remark code N94 indicates that the claim or service was denied because a more specific taxonomy code is required for adjudication. This means that the billing submission must include a more detailed classification of the provider's specialty or type of service provided to process the claim successfully.
Common causes of code N94 are:
1. Use of a general or broad taxonomy code when the payer requires a more specific code to determine the specialty or provider type for proper claim adjudication.
2. Submission of a claim with an outdated or incorrect taxonomy code that does not match the services provided.
3. Failure to update the provider's information with the payer to reflect a change in specialty or services that require a different taxonomy code.
4. Lack of specificity in the taxonomy code that does not align with the current billing practices or payer's guidelines for the particular service or procedure.
5. Inadvertent selection of a default or placeholder taxonomy code that does not accurately represent the provider's credentials or the service rendered.
Ways to mitigate code N94 include ensuring that the billing staff is thoroughly trained on the use of taxonomy codes and their importance in the claims adjudication process. Implement a system of checks and balances to verify that the most specific and accurate taxonomy code is selected for each healthcare provider when submitting claims. Regularly review and update the provider's taxonomy codes in the National Provider Identifier (NPI) database to reflect their current specialty or subspecialty. Utilize coding resources and tools that can assist in identifying the most appropriate taxonomy codes based on the services provided. Additionally, conduct periodic audits of claims to identify patterns of denials related to taxonomy codes and address any issues promptly.
The steps to address code N94 involve reviewing the claim to identify the general taxonomy code that was used. Next, consult the provider's credentials and services rendered to determine the most specific and appropriate taxonomy code that accurately reflects the provider's specialty or subspecialty. Update the claim with this more specific taxonomy code. Once the claim has been corrected, resubmit it to the payer for adjudication. It's also advisable to document the changes made and monitor the resubmitted claim to ensure it is processed correctly. If the issue persists, contact the payer for further clarification on the specific taxonomy code they require for the service in question.