How To Fix Remark Code M680 (RARC) | Common Reasons, Next Steps & How To Avoid It

Remark Code N473 means that there is missing certification. This code is used to indicate that the necessary certification or authorization for a particular service or procedure is missing. Healthcare providers and insurance companies utilize this code to explain the reason for denial or adjustment of a claim due to missing certification.

1. Description

Remark Code N473 indicates that there is missing certification for a specific service or procedure. The official description states: ‘Missing certification.’ This means that the required documentation or authorization for the service or procedure in question is not provided or is incomplete. Certification is crucial for proper billing and to ensure that the service or procedure meets the necessary criteria for coverage.

2. Common Reasons

1. Failure to obtain prior authorization: In some cases, healthcare providers are required to obtain prior authorization from the insurance company before performing certain services or procedures. Failure to obtain this authorization can result in missing certification.
2. Incomplete documentation: If the necessary documentation, such as medical records or supporting documentation, is incomplete or missing, it can lead to missing certification.
3. Expired certification: Some certifications have an expiration date. If the certification is not renewed or updated in a timely manner, it can result in missing certification.
4. Incorrect or invalid certification: If the certification provided does not meet the specific requirements or is deemed invalid, it can result in missing certification.

3. Next Steps

1. Contact the healthcare provider for the missing certification: If the certification is missing or incomplete, it is important to reach out to the healthcare provider to obtain the necessary documentation or authorization.
2. Verify the requirements for certification: Review the specific requirements for certification to ensure that all necessary criteria are met.
3. Submit the missing certification: Once the missing certification is obtained, submit it to the appropriate party, such as the insurance company or billing department, to rectify the issue.

4. How To Avoid It

1. Understand the certification requirements: Familiarize yourself with the specific certification requirements for different services or procedures to ensure compliance.
2. Obtain prior authorization when necessary: If prior authorization is required, make sure to obtain it before performing the service or procedure.
3. Ensure documentation is complete and accurate: Double-check that all necessary documentation is complete and accurate before submitting it for certification.
4. Stay updated on certification expiration dates: Keep track of any certifications that have expiration dates and make sure to renew or update them in a timely manner.

5. Example Cases

1. Case 1: A claim is denied because the certification for a surgical procedure is missing. The healthcare provider failed to obtain the necessary authorization from the insurance company before performing the procedure.
2. Case 2: A claim adjustment occurs because the certification for a specialized diagnostic test is incomplete. The healthcare provider did not provide all the required documentation to support the certification.

Source: Remittance Advice Remark Codes