How To Fix Remark Code M262 (RARC) | Common Reasons, Next Steps & How To Avoid It

Remark Code N36 means that a claim must meet the primary payer’s processing requirements before it can be considered for payment. This code is used to indicate that there are specific criteria or conditions that need to be met in order for the claim to be processed and potentially reimbursed.

1. Description

Remark Code N36 indicates that a claim must meet the primary payer’s processing requirements before it can be considered for payment. The official description states: ‘Claim must meet primary payer’s processing requirements before we can consider payment.’ This remark code highlights the importance of adhering to the specific guidelines and criteria set by the primary payer in order to ensure proper processing and reimbursement of claims.

2. Common Reasons

1. Missing or incomplete documentation: One common reason for Remark Code N36 is when the claim is missing or has incomplete documentation. This could include missing patient information, incomplete medical records, or lack of supporting documentation for the services rendered.
2. Incorrect coding: Another common reason for Remark Code N36 is when the claim contains incorrect coding. This could involve using incorrect procedure codes, diagnosis codes, or modifiers that do not align with the primary payer’s coding guidelines.
3. Failure to meet specific criteria: Remark Code N36 may also be triggered when the claim fails to meet specific criteria set by the primary payer. This could include requirements such as pre-authorization, medical necessity, or specific documentation requirements for certain procedures or services.
4. Non-compliance with billing guidelines: Non-compliance with the primary payer’s billing guidelines can also result in Remark Code N36. This could involve issues such as incorrect billing format, failure to follow specific billing instructions, or failure to submit claims within the designated timeframe.

3. Next Steps

1. Review the primary payer’s processing requirements: The first step in addressing Remark Code N36 is to carefully review the primary payer’s processing requirements. This may involve consulting the payer’s billing guidelines, policy manuals, or contacting the payer directly for clarification.
2. Identify the specific reason for the code: Once the processing requirements have been reviewed, it is important to identify the specific reason for Remark Code N36. This could involve assessing the claim for missing documentation, incorrect coding, or failure to meet specific criteria.
3. Take appropriate action to address the issue: Based on the identified reason, appropriate action should be taken to address the issue. This may include obtaining and submitting missing documentation, correcting coding errors, or fulfilling any outstanding requirements set by the primary payer.
4. Resubmit the claim: After addressing the issue, the claim should be resubmitted to the primary payer for reconsideration. It is important to ensure that all necessary corrections have been made and that the claim now meets the processing requirements.

4. How To Avoid It

1. Thoroughly review and understand the primary payer’s guidelines: To avoid Remark Code N36, it is crucial to thoroughly review and understand the primary payer’s guidelines. This includes familiarizing oneself with the specific processing requirements, documentation guidelines, coding guidelines, and any other criteria set by the payer.
2. Ensure accurate and complete documentation: Accurate and complete documentation is essential to avoid Remark Code N36. This includes capturing all relevant patient information, documenting services rendered in detail, and including any necessary supporting documentation as per the primary payer’s requirements.
3. Adhere to correct coding practices: Following correct coding practices is vital to prevent Remark Code N36. This involves using the appropriate procedure codes, diagnosis codes, and modifiers that align with the primary payer’s coding guidelines. Regular training and staying updated with coding changes can help in maintaining compliance.
4. Comply with billing guidelines: Strict adherence to the primary payer’s billing guidelines is necessary to avoid Remark Code N36. This includes following the correct billing format, submitting claims within the designated timeframe, and ensuring compliance with any specific billing instructions provided by the payer.

5. Example Cases

1. Case 1: A claim is denied with Remark Code N36 because the required pre-authorization was not obtained prior to providing the service. This case highlights the importance of obtaining necessary authorizations to meet the primary payer’s processing requirements.
2. Case 2: A claim is adjusted with Remark Code N36 due to incorrect coding, where the procedure code used does not align with the primary payer’s coding guidelines. This case emphasizes the significance of accurate coding to ensure proper claim processing.

Source: Remittance Advice Remark Codes