How To Fix Remark Code M794 (RARC) | Common Reasons, Next Steps & How To Avoid It

Remark Code N592 means that the claim has been adjusted because it is not the initial prescription or it exceeds the amount allowed for the initial prescription. This code is used to indicate the reason for denial or adjustment of a claim related to prescription medications.

1. Description

Remark Code N592 indicates that the claim has been adjusted because it does not meet the criteria for the initial prescription or it exceeds the allowed amount for the initial prescription. The official description states: ‘Adjusted because this is not the initial prescription or exceeds the amount allowed for the initial prescription.’ This remark code is important for ensuring that claims for prescription medications are properly reviewed and adjusted based on the specific requirements.

2. Common Reasons

1. Not the initial prescription: This means that the claim is for a medication that is not the first prescription for the patient. It may be a refill or a subsequent prescription for an ongoing treatment.
2. Exceeds the amount allowed for the initial prescription: In some cases, there may be limitations on the quantity or dosage of a medication that can be prescribed as an initial prescription. If the claim exceeds these limits, it may be adjusted accordingly.

3. Next Steps

1. Review the claim details: Carefully examine the claim to determine if it is indeed not the initial prescription or if it exceeds the allowed amount for the initial prescription.
2. Verify the patient’s prescription history: Check the patient’s medical records to confirm if the medication in question is a refill or subsequent prescription.
3. Adjust the claim accordingly: If the claim is found to be not the initial prescription or if it exceeds the allowed amount, make the necessary adjustments to reflect the correct information.

4. How To Avoid It

1. Ensure accurate prescription documentation: Properly document the prescription details, including whether it is the initial prescription or a refill.
2. Review prescription limits: Familiarize yourself with any limitations on the quantity or dosage of medications that can be prescribed as an initial prescription.
3. Verify patient’s prescription history: Before submitting a claim, check the patient’s prescription history to ensure that the medication in question is indeed the initial prescription.

5. Example Cases

1. Case 1: A claim for a medication is adjusted because it is a refill and not the initial prescription, highlighting the importance of accurately documenting prescription details.
2. Case 2: A claim is adjusted because the prescribed quantity of a medication exceeds the allowed amount for the initial prescription, emphasizing the need to review prescription limits.

Source: Remittance Advice Remark Codes