How To Fix Remark Code M473 (RARC) | Common Reasons, Next Steps & How To Avoid It

Remark Code N264 means that there is a missing, incomplete, or invalid ordering provider name. This code is used to indicate the reason for denial or adjustment of a claim when the ordering provider’s name is not properly documented or does not meet the required criteria.

1. Description

Remark Code N264 signifies that there is an issue with the ordering provider’s name. The official description states: ‘Missing/incomplete/invalid ordering provider name.’ This remark code is used when the name of the healthcare professional who ordered the services is not provided, is incomplete, or does not meet the necessary requirements. Accurate documentation of the ordering provider’s name is crucial for proper claim processing and reimbursement.

2. Common Reasons

1. Missing ordering provider name: In some cases, the ordering provider’s name may not be included in the claim documentation, leading to the remark code N264.
2. Incomplete ordering provider name: If the ordering provider’s name is partially documented or lacks essential details, such as credentials or identifiers, the claim may be flagged with remark code N264.
3. Invalid ordering provider name: When the ordering provider’s name does not meet the required criteria, such as incorrect spelling, wrong format, or unrecognized credentials, the claim may be denied or adjusted with remark code N264.

3. Next Steps

1. Obtain the complete ordering provider name: Contact the healthcare provider or review the medical records to ensure that the ordering provider’s name is accurately documented.
2. Verify the ordering provider’s credentials: Confirm that the ordering provider’s credentials, such as their license or certification, are valid and up to date.
3. Update the claim documentation: If the ordering provider’s name is missing or incomplete, make the necessary updates to the claim documentation to include the correct and complete name.

4. How To Avoid It

1. Ensure accurate documentation: Properly document the ordering provider’s name, including their full name, credentials, and any required identifiers.
2. Verify ordering provider information: Before submitting a claim, double-check the accuracy of the ordering provider’s name and credentials to avoid any potential issues.
3. Stay updated with credentialing requirements: Stay informed about any changes or updates to the credentialing requirements for ordering providers to ensure compliance.

5. Example Cases

1. Case 1: A claim is denied because the ordering provider’s name is missing from the documentation, highlighting the importance of accurate and complete information.
2. Case 2: A claim adjustment occurs due to an invalid ordering provider name, emphasizing the need for proper documentation and adherence to credentialing requirements.

Source: Remittance Advice Remark Codes