How To Fix Remark Code M400 (RARC) | Common Reasons, Next Steps & How To Avoid It

Remark Code N189 means that a service has been paid as a one-time exception to the plan’s benefit restrictions. This code is used to alert healthcare providers and insurance companies that the service in question was covered despite exceeding the usual limitations or restrictions set by the plan.

1. Description

Remark Code N189 indicates that a service has been paid as a one-time exception to the plan’s benefit restrictions. The official description states: ‘Alert: This service has been paid as a one-time exception to the plan’s benefit restrictions.’ This means that the service in question was covered even though it exceeded the usual limitations or restrictions set by the plan.

2. Common Reasons

1. Medical necessity: The service may have been deemed medically necessary by the healthcare provider, warranting an exception to the plan’s restrictions.
2. Emergency situation: If the service was provided in an emergency situation, the plan may have made an exception to ensure timely and appropriate care.
3. Special circumstances: Certain special circumstances, such as unique patient needs or rare medical conditions, may have warranted an exception to the plan’s restrictions.
4. Appeal or review process: The healthcare provider may have gone through an appeal or review process to demonstrate the necessity of the service and request an exception.

3. Next Steps

1. Review the payment details: Carefully review the payment details to understand the specific reason for the one-time exception and ensure accurate reimbursement.
2. Document the justification: Keep detailed documentation of the medical necessity or special circumstances that led to the exception, as this may be required for future reference or audits.
3. Communicate with the plan: If there are any questions or concerns regarding the one-time exception, reach out to the plan’s representative for clarification or further information.

4. How To Avoid It

1. Follow plan guidelines: Adhere to the plan’s benefit restrictions and guidelines to minimize the need for one-time exceptions.
2. Ensure accurate documentation: Properly document the medical necessity or special circumstances that may warrant an exception, providing clear and detailed information to support the request.
3. Utilize pre-authorization: Whenever possible, obtain pre-authorization for services that may exceed the plan’s restrictions to avoid potential denials or the need for one-time exceptions.

5. Example Cases

1. Case 1: A claim for a specialized surgery is paid as a one-time exception due to the rare medical condition of the patient, demonstrating the need for individualized care.
2. Case 2: A claim for an out-of-network emergency room visit is covered as a one-time exception to ensure timely access to care during an urgent situation.

Source: Remittance Advice Remark Codes