N113Remark Code (RARC)Active
N113 Remark Code: Initial Visit Coverage Limit
The N113 remark code indicates that the payer covers only one initial visit per physician, group practice, or provider. This means that any additional claims for initial visits beyond the first will not be reimbursed under the current policy.
How It Relates to the Denial
The N113 remark typically accompanies adjustment reason codes that indicate a denial or reduction of payment due to multiple initial visit claims. The combination of these codes signals that the provider has billed for more than one initial visit, which is not permissible under the payer's policy.
Common Scenarios
1A provider submits a claim for an initial visit for a patient and later bills for a second initial visit for the same patient within a short timeframe.
→ The N113 remark informs the biller that the second claim was denied because only one initial visit is allowed per provider for that patient.
2A group practice submits multiple claims for initial consultations for different patients but mistakenly bills for an initial visit again for a patient already seen.
→ The N113 remark indicates that the payer will not cover the additional initial visit as it exceeds the allowable limit of one per provider.
3A provider receives a denial for an initial visit after previously billing for another initial visit for the same patient within the same calendar year.
→ The N113 remark clarifies that the payer's policy restricts reimbursement to a single initial visit per provider, leading to the denial of the second claim.
What to Do
- Verify that only one initial visit has been billed for the patient within the allowed timeframe.
- If a second initial visit was billed in error, consider correcting the claim to reflect only the first visit and resubmit it.
What to Check
- Review the patient's claim history to confirm if there was a prior initial visit billed by the same provider.
- Consult the payer's policy documentation regarding initial visit coverage limits to ensure compliance with their rules.
- Examine the adjustment reason code accompanying the N113 remark for additional context on the denial.