If you’ve received a claim denial with Remark Code N117, it means the billed service is restricted to a one-time benefit in the patient’s lifetime. This restriction often applies to high-value medical services like initial therapy evaluations or specific surgeries. For practice managers, providers, and healthcare business owners, understanding and managing N117-related denials is essential for protecting your revenue and ensuring accurate billing.
Why Claims Are Denied with Remark Code N117
There are several common reasons your claims might be denied with this code:
- Exceeded Lifetime Benefit Limit: The patient has already used the one-time benefit, so any repeat claim for the same service is automatically denied.
- Duplicate Billing: Whether intentional or accidental, submitting a duplicate claim for a one-time-only service will trigger a denial.
- Insufficient Documentation: Payers may deny a claim if there’s not enough proof to support the medical necessity of the service.
- Billing or Coding Errors: Mistakes in medical codes or incorrect claim formatting can lead to unnecessary denials.
- Provider Communication Gaps: Without clear communication between providers, the same service might be unknowingly repeated.
How to Prevent N117 Denials
Avoiding N117 denials begins with proactive systems and a well-trained team. Here’s what you can do:
Review Patient History Thoroughly
- Before scheduling or billing a service, verify whether the patient has already received that service in the past.
- Include strong documentation that highlights the medical necessity and uniqueness of the procedure.
Leverage Technology for Scheduling and EHRs
- Use advanced scheduling systems that flag services limited by lifetime benefits.
- Ensure your Electronic Health Record (EHR) system captures all relevant past procedures and alerts you to potential conflicts.
Accurate Billing and Coding Practices
- Make sure that your billing staff is up-to-date on current coding guidelines and payer-specific policies.
- Regular audits of coding and claim submissions can catch errors early and prevent denials.
Enhance Inter-Provider Communication
- Implement secure messaging systems to ensure care teams share patient treatment details and avoid duplicate services.
- Establish clear communication protocols across departments or with referring providers.
Build a Strong Appeals Process
- When denials occur, respond quickly with a comprehensive appeal.
- Collect and submit all supporting documentation that proves the service was medically necessary or mistakenly denied.
Maximize Revenue with Claims Med
Denials like N117 can disrupt your revenue flow and slow down operations. At Claims Med, we help healthcare practices prevent denials, strengthen billing workflows, and optimize revenue cycle management from end to end.
Let our expert team handle the complexity of medical billing and payer communication. Whether you need help appealing denials or tightening your front-end billing process, we’ve got you covered.
Contact Claims Med today to streamline your claims process and reduce costly denials like N117.