How To Fix Remark Code M681 (RARC) | Common Reasons, Next Steps & How To Avoid It

Remark Code N474 means that there is an issue with the certification provided, either it is incomplete or invalid. This code is used to indicate the reason for denial or adjustment of a claim related to certification. It is important to address this remark code promptly to ensure accurate billing and reimbursement.

1. Description

Remark Code N474 signifies that the certification provided for a claim is either incomplete or invalid. The official description states: ‘Incomplete/invalid certification.’ This remark code is crucial for identifying and resolving issues with certification, which is essential for proper billing and reimbursement.

2. Common Reasons

1. Incomplete certification: This may occur when the required information or documentation is missing from the certification. It is important to ensure that all necessary details are included to avoid this remark code.
2. Invalid certification: An invalid certification may be due to various reasons, such as expired credentials or certifications from unauthorized individuals. It is crucial to verify the validity of certifications before submitting claims.

3. Next Steps

1. Review the certification: Carefully examine the certification provided to identify any missing or incomplete information. Contact the healthcare provider or the certifying authority for clarification or additional documentation.
2. Verify the validity of the certification: Ensure that the certification is current and issued by an authorized individual or organization. If the certification is invalid, request an updated or valid certification from the healthcare provider.
3. Submit the corrected certification: Once the missing or incomplete information is obtained or the invalid certification is replaced, submit the corrected certification along with the claim to avoid further denials or adjustments.

4. How To Avoid It

1. Ensure complete certification: Double-check that all required information is included in the certification before submitting the claim. This includes patient details, provider information, dates, and any other relevant information.
2. Verify certification validity: Confirm the validity of the certification by checking the expiration date and ensuring it is issued by an authorized individual or organization. Keep track of certification renewal dates to avoid submitting claims with expired certifications.
3. Communicate with healthcare providers: Establish clear communication with healthcare providers to ensure they understand the certification requirements and provide accurate and complete certifications.

5. Example Cases

1. Case 1: A claim is denied due to incomplete certification, as the required patient information was missing. The healthcare provider reviews the certification, obtains the missing information, and resubmits the claim with the complete certification.
2. Case 2: An adjustment is made to a claim because the certification provided was invalid, as it was issued by an unauthorized individual. The healthcare provider obtains a valid certification from an authorized source and resubmits the claim with the updated certification.

Source: Remittance Advice Remark Codes