How To Fix Remark Code M671 (RARC) | Common Reasons, Next Steps & How To Avoid It

Remark Code N464 means that there is incomplete or invalid support data for a claim. This code is used to indicate that the necessary documentation or information to support the claim is missing or incorrect. Healthcare providers and insurance companies utilize this code to explain the reason for denial or adjustment of a claim.

1. Description

Remark Code N464 indicates that there is incomplete or invalid support data for a claim. The official description states: ‘Incomplete/invalid support data for claim.’ This means that the documentation or information required to support the claim is either missing or does not meet the necessary criteria. It is crucial to provide complete and accurate support data to ensure proper processing and reimbursement of claims.

2. Common Reasons

1. Incomplete documentation: One of the most common reasons for Remark Code N464 is incomplete documentation. This could include missing medical records, test results, or other supporting documents that are necessary to validate the claim.
2. Invalid or incorrect information: Another common reason is the presence of invalid or incorrect information in the claim. This could include inaccurate patient demographics, incorrect procedure codes, or other data that does not align with the services provided.
3. Lack of authorization: Claims may also receive Remark Code N464 if there is a lack of proper authorization for the services rendered. This could include procedures that require pre-authorization or referrals from other healthcare professionals.
4. Missing or incomplete coding: In some cases, the claim may lack proper coding, such as missing diagnosis codes or incorrect modifiers. This can result in Remark Code N464 as the claim lacks the necessary information for accurate processing.

3. Next Steps

1. Review the claim: The first step is to thoroughly review the claim to identify the specific areas where the support data is incomplete or invalid. This may involve cross-referencing the claim with the medical records and other relevant documentation.
2. Obtain missing documentation: If there are missing documents or information, reach out to the healthcare provider or other relevant parties to obtain the necessary support data. This may involve requesting medical records, test results, or other documentation to validate the claim.
3. Correct any inaccuracies: If there are any inaccuracies or errors in the claim, take the necessary steps to correct them. This may involve updating patient demographics, revising procedure codes, or ensuring proper authorization is obtained.
4. Resubmit the claim: Once all the necessary support data has been obtained and any inaccuracies have been corrected, resubmit the claim for processing. Ensure that all the required documentation is included and properly coded to avoid further issues.

4. How To Avoid It

1. Ensure complete documentation: To avoid Remark Code N464, healthcare providers should ensure that all necessary documentation is complete and accurate. This includes medical records, test results, referrals, and any other supporting documents required for the claim.
2. Double-check information: It is essential to double-check all the information entered in the claim, including patient demographics, procedure codes, and modifiers. Verifying the accuracy of the data before submission can help prevent errors and potential denials.
3. Obtain proper authorization: For procedures that require pre-authorization or referrals, healthcare providers should ensure that the necessary authorization is obtained before rendering the services. This helps avoid denials due to a lack of proper authorization.
4. Stay updated with coding guidelines: Keeping up-to-date with coding guidelines and requirements is crucial to ensure accurate coding and avoid coding-related denials. Regular training and education can help healthcare providers stay informed about any changes or updates in coding practices.

5. Example Cases

1. Case 1: A claim is denied due to incomplete medical records, resulting in Remark Code N464. The healthcare provider reviews the claim, obtains the missing documentation, and resubmits the claim with the complete support data, leading to successful reimbursement.
2. Case 2: A claim is adjusted because the procedure code entered is incorrect, triggering Remark Code N464. The healthcare provider identifies the error, corrects the code, and resubmits the claim with the accurate information, resulting in proper reimbursement.

Source: Remittance Advice Remark Codes