How To Fix Remark Code M865 (RARC) | Common Reasons, Next Steps & How To Avoid It

Remark Code N665 means that services provided by an unlicensed provider are not reimbursable. This code is used to indicate the reason for denial or adjustment of a claim related to services rendered by an unlicensed healthcare provider.

1. Description

Remark Code N665 indicates that the services were provided by an unlicensed provider, making them ineligible for reimbursement. The official description states: ‘Services by an unlicensed provider are not reimbursable.’ This remark code serves as a reminder to ensure that all healthcare providers are properly licensed and authorized to practice.

2. Common Reasons

1. Provider lacks the necessary license: This may occur when a healthcare provider does not possess the required license or certification to perform specific services.
2. Provider’s license has expired or been revoked: If a provider’s license has expired or been revoked, any services rendered during that period may not be reimbursable.
3. Provider’s license does not cover the specific services: Some licenses may have limitations or restrictions on the types of services that can be provided.
4. Provider’s license is from a different jurisdiction: In some cases, a provider’s license may not be recognized in the jurisdiction where the services were rendered, resulting in non-reimbursement.

3. Next Steps

1. Contact the healthcare provider: Reach out to the provider to discuss the issue and determine if there are any steps that can be taken to rectify the situation.
2. Verify the provider’s license: Confirm the validity and scope of the provider’s license to ensure compliance with reimbursement requirements.
3. Consider alternative providers: If the services provided by the unlicensed provider are essential, explore options for obtaining the same services from a licensed provider.

4. How To Avoid It

1. Verify the provider’s license before seeking services: Prior to receiving any healthcare services, ensure that the provider is properly licensed and authorized to practice.
2. Regularly check the status of the provider’s license: Stay updated on any changes to the provider’s license, such as expiration or revocation.
3. Consult with insurance companies: Seek guidance from insurance companies to ensure that the services provided by a specific provider will be reimbursable.

5. Example Cases

1. Case 1: A claim for services rendered by an unlicensed provider is denied, emphasizing the importance of verifying the provider’s credentials before seeking treatment.
2. Case 2: A claim adjustment occurs because the provider’s license does not cover the specific services provided, highlighting the need for clarity on the scope of practice.

Source: Remittance Advice Remark Codes