N188Remark Code (RARC)Active
N188 Remark Code - Care Level Mismatch Explained
The N188 remark code indicates that the approved level of care for a patient does not align with the procedure code that was billed. This suggests that the service provided may not meet the criteria for the level of care authorized or expected by the payer.
How It Relates to the Denial
N188 typically accompanies adjustment reason codes that indicate a denial related to care level discrepancies. The combination signals that while an adjustment has been made, additional clarification on the procedure code's appropriateness is required.
Common Scenarios
1A provider billed for a surgical procedure, but the remittance response included an adjustment reason code stating that the procedure was not covered. The N188 remark appeared alongside it.
→ In this case, the N188 remark suggests that the payer believes the procedure code submitted does not correspond with the level of care that was approved for the patient.
2A therapy session was billed, but the remittance indicates a denial due to the procedure code not matching the approved care level. The N188 remark accompanies this denial.
→ Here, the N188 remark indicates that the billed therapy service does not align with what the payer authorized for the patient's care level.
3An emergency service was billed, but the remittance included an adjustment that the service is not covered, with N188 noted.
→ This means that the N188 remark points out that the emergency service billed does not match the approved level of care expected by the payer.
What to Do
- Review the procedure code submitted for accuracy against the services provided.
- Check the patient's approved level of care to ensure the billed service corresponds with it.
- Consider submitting additional documentation that supports the necessity of the billed procedure.
What to Check
- The patient's prior authorization documentation to confirm the approved level of care.
- The claim details to verify the procedure code used was billed correctly.
- Any notes or communications from the payer regarding the patient's care level requirements.