How To Fix Remark Code M315 (RARC) | Common Reasons, Next Steps & How To Avoid It

Remark Code N95 means that this provider type/provider specialty may not bill this service. This code is used to indicate that certain providers are not eligible to bill for specific services, which can result in claim denials or adjustments.

1. Description

Remark Code N95 indicates that this provider type/provider specialty may not bill for a particular service. The official description states: ‘This provider type/provider specialty may not bill this service.’ This remark code is designed to prevent certain providers from billing for services that are outside their scope of practice or expertise.

2. Common Reasons

1. Provider type or specialty is not authorized for the service: Certain services may require specialized training or qualifications that are not possessed by all providers. In such cases, the remark code N95 is used to indicate that the provider is not eligible to bill for that particular service.
2. Service is not within the scope of practice for the provider: Each provider has a defined scope of practice that outlines the services they are authorized to provide. If a service falls outside this scope, the provider may not be able to bill for it, resulting in the use of remark code N95.
3. Service is not covered by the provider’s specialty: Providers often have specific specialties or areas of expertise. If a service is not within the covered scope of their specialty, they may not be eligible to bill for it, leading to the application of remark code N95.

3. Next Steps

1. Review the provider’s qualifications and scope of practice: It is essential to ensure that the provider is authorized and qualified to perform the service in question. This may involve reviewing their credentials, certifications, and training.
2. Consult with the provider or seek a second opinion: If there is uncertainty regarding the provider’s eligibility to bill for a specific service, it may be necessary to consult with them directly or seek a second opinion from another qualified professional.
3. Consider alternative providers or specialties: If the provider is not authorized to bill for the service, it may be necessary to seek an alternative provider or specialty that is eligible to provide the required service.

4. How To Avoid It

1. Ensure providers are aware of their scope of practice: Providers should have a clear understanding of the services they are authorized to provide based on their qualifications and specialty.
2. Regularly review and update provider credentials: It is important to regularly review and update provider credentials to ensure they remain eligible to bill for the services they offer.
3. Verify coverage and eligibility before providing services: Before providing a service, it is crucial to verify that the service is covered by the provider’s specialty and that they are eligible to bill for it.

5. Example Cases

1. Case 1: A claim for a specialized surgical procedure is denied because the provider’s specialty does not cover that particular procedure, highlighting the importance of verifying coverage before providing services.
2. Case 2: A claim adjustment occurs because the provider type is not authorized to bill for a specific service, emphasizing the need to ensure providers are aware of their limitations.

Source: Remittance Advice Remark Codes