How To Fix Remark Code M573 (RARC) | Common Reasons, Next Steps & How To Avoid It

Remark Code N366 means that requested information was not provided. This code is used to indicate that a claim has been denied due to missing or incomplete information. However, the claim can be reopened if the requested information is submitted within one year after the date of the denial notice.

1. Description

Remark Code N366 indicates that requested information was not provided. The official description states: ‘The claim will be reopened if the information previously requested is submitted within one year after the date of this denial notice.’ This remark code is used when a claim is denied due to missing or incomplete information, but there is an opportunity to rectify the situation by providing the necessary documentation within a specified timeframe.

2. Common Reasons

1. Missing documentation: One of the most common reasons for Remark Code N366 is the absence of required documentation. This could include medical records, test results, or other supporting documents necessary for claim processing.
2. Incomplete information: Another common reason is when the submitted information is incomplete or lacks essential details. This can hinder the evaluation and processing of the claim, leading to a denial.
3. Failure to respond to information requests: Sometimes, healthcare providers or billing departments fail to respond to requests for additional information from the insurance company. This can result in a denial if the requested information is not provided within the specified timeframe.

3. Next Steps

1. Review the denial notice: Carefully examine the denial notice to understand the specific information that is missing or incomplete.
2. Contact the insurance company: Reach out to the insurance company to clarify the requested information and ensure you have a clear understanding of what needs to be provided.
3. Gather the necessary documentation: Collect all the required documentation, such as medical records, test results, or any other supporting documents that were requested.
4. Submit the requested information: Send the requested information to the insurance company within the specified timeframe, ensuring it is complete and accurate.

4. How To Avoid It

1. Thoroughly review claim requirements: Familiarize yourself with the specific documentation and information required for each claim to avoid any omissions or errors.
2. Respond promptly to information requests: When the insurance company requests additional information, make it a priority to provide the necessary documentation within the given timeframe.
3. Double-check submitted information: Before submitting a claim, ensure that all the required information is complete, accurate, and meets the insurance company’s guidelines.
4. Maintain organized records: Keep a well-organized system for storing and retrieving necessary documentation, making it easier to respond to information requests promptly.

5. Example Cases

1. Case 1: A claim for a surgical procedure is denied due to missing operative notes. The healthcare provider promptly submits the missing documentation within the specified timeframe, and the claim is reopened and processed successfully.
2. Case 2: A claim for diagnostic imaging is denied because the submitted test results were incomplete. The healthcare provider contacts the insurance company, gathers the missing information, and resubmits the claim with the complete documentation. The claim is subsequently approved.

Source: Remittance Advice Remark Codes