How To Fix Remark Code M813 (RARC) | Common Reasons, Next Steps & How To Avoid It

Remark Code N611 means that a claim is in litigation and requires further information from the insurer. This code is used to indicate that the claim is currently involved in a legal dispute or lawsuit, and additional details need to be obtained from the insurance company.

1. Description

Remark Code N611 signifies that a claim is in litigation and requires contact with the insurer for more information. The official description states: ‘Claim in litigation. Contact insurer for more information.’ This code is typically used when a claim is being disputed or is the subject of a legal proceeding, and further clarification is needed from the insurance provider.

2. Common Reasons

1. Disputed coverage: The claim may be in litigation due to a disagreement between the healthcare provider and the insurance company regarding coverage or reimbursement.
2. Medical necessity concerns: The insurer may be questioning the medical necessity of the services or treatment provided, leading to a legal dispute.
3. Contractual disputes: The claim may be in litigation due to contractual disagreements between the healthcare provider and the insurance company.
4. Fraud or abuse allegations: The insurer may suspect fraudulent or abusive practices, leading to a legal investigation and claim litigation.

3. Next Steps

1. Contact the insurer for more information: Reach out to the insurance company to gather additional details about the claim in litigation.
2. Provide requested documentation or evidence: If the insurer requires specific documentation or evidence to support the claim, ensure that it is promptly provided.
3. Follow any legal procedures or requirements: If the claim is involved in a legal proceeding, consult with legal counsel to navigate the necessary steps and requirements.

4. How To Avoid It

1. Ensure accurate and complete claim submission: Submitting claims with accurate and comprehensive information can help minimize the chances of a claim ending up in litigation.
2. Communicate effectively with the insurer: Maintain open lines of communication with the insurance company to address any concerns or disputes promptly.
3. Adhere to medical necessity guidelines: Ensure that all services and treatments provided meet the insurer’s medical necessity criteria to avoid potential disputes.

5. Example Cases

1. Case 1: A claim for a complex surgical procedure is in litigation due to a disagreement between the healthcare provider and the insurance company regarding coverage and reimbursement.
2. Case 2: A claim for a specialized diagnostic test is under legal dispute as the insurer questions the medical necessity of the procedure.

Source: Remittance Advice Remark Codes