One of the most common reasons for healthcare claims to be denied is due to Remark Code N95: “This provider type/provider specialty may not bill this service.” This denial typically occurs when there’s a mismatch between the provider’s credentials and the service being billed. Understanding the causes of N95 denials and implementing effective solutions is essential for practice managers, healthcare providers, and owners to ensure a smooth revenue cycle.
Common Causes of N95 Denials
- Inconsistency Between Procedure Code and Provider Type/Specialty: Ensure the procedure code aligns with the provider’s taxonomy to avoid mismatches.
- Non-Covered Services: Verify if the service is covered by the payer’s guidelines to prevent unnecessary denials.
- Incorrect Billing Party: Double-check if the service was performed by the attending physician or a different practitioner/supplier.
- Out-of-Network or Unauthorized Services: Confirm if the provider is in-network and if necessary authorizations were obtained prior to service delivery.
- Assistant at Surgery Procedure: Ensure that the assistant’s role aligns with the payer’s guidelines to avoid billing issues.
- Plan Procedures Not Followed: Adhere to the payer’s specific plan procedures to ensure compliance.
- Invalid Claim Type for Hospice: Verify that the claim type is appropriate for Hospice services to avoid denials.
Solutions to Prevent N95 Denials
To minimize the risk of N95 denials, healthcare providers should implement the following strategies:
- Align Billing Practices with Provider Credentials: Regularly review and update provider information to ensure accuracy in billing.
- Cross-Check Provider Type and Specialty: Verify that the provider’s credentials match the services being billed to prevent discrepancies.
- Correct Provider Information: If errors are found, promptly update the provider’s type and specialty in billing records.
- Contact the Payer: If a denial occurs despite accurate billing, reach out to the payer to discuss the discrepancy and seek clarification.
- Implement an Internal Audit Process: Regularly review provider credentials against billed services to identify and address potential issues proactively.
Partner with Claims Med for Revenue Cycle Management
By addressing the root causes of N95 denials and implementing effective solutions, healthcare practices can significantly improve their revenue cycle. Claims Med offers comprehensive revenue cycle management solutions tailored to the needs of practice managers and healthcare providers. Our experts can help you streamline your billing processes, reduce denials, and maximize your revenue.
Contact us today to learn more about how Claims Med can assist your practice in navigating the complexities of healthcare billing.