N137Remark Code (RARC)ActiveInformational Alert
N137 Remark Code - Appeal and Complaint Options
The N137 remark code is an alert indicating that the provider can take specific actions on behalf of the member. It informs that an appeal can be filed with the payer, and in cases involving urgent conditions where care has not yet been rendered, the provider may also file a complaint with the State Insurance Regulatory Authority without prior appeal.
What This Alert Tells You
As an informational alert, the N137 remark code does not accompany any specific adjustment or denial reason codes. Instead, it serves to guide providers regarding the options available to them and their patients in situations involving coverage decisions.
Common Scenarios
1A provider receives a remittance advice indicating a claim denial for a procedure related to an urgent medical condition. The claim was denied based on a coverage decision.
→ The N137 alert suggests that the provider has the option to file an appeal with the payer regarding the denial. Additionally, since the condition is urgent and care has not been rendered, the provider can also file a complaint with the State Insurance Regulatory Authority.
2A provider's office is reviewing a claim submission for a member that was denied, but the office believes the denial was incorrect due to the urgency of the medical situation.
→ The presence of the N137 remark code indicates that the provider may appeal the denial to the payer. Furthermore, they can directly contact the State Insurance Regulatory Authority to file a complaint if the situation is urgent.
3A member's claim for an urgent surgery was denied by the payer, and the provider is assessing their options to assist the member.
→ The N137 alert informs the provider that they can file an appeal on behalf of the member. If the surgery was urgent and care has not yet been provided, they can also escalate the issue to the State Insurance Regulatory Authority.
What to Do
- Consider filing an appeal with the payer on behalf of the member.
- If applicable, prepare to file a complaint with the State Insurance Regulatory Authority regarding the urgent condition.
What to Check
- Review the member's coverage details to understand the basis for the denial.
- Check the urgency of the medical condition related to the claim.
- Obtain the address and contact information for the State Insurance Regulatory Authority.