N218Remark Code (RARC)Active
N218 Remark Code - Maintenance and Service Requirements
The N218 remark code indicates that the payer expects the provider to furnish and service the billed item for the duration of the patient's need. It clarifies that maintenance and servicing may be covered as long as it aligns with the terms outlined in the contract or coverage manual.
How It Relates to the Denial
The N218 remark code typically accompanies a claim adjustment reason code related to payment reductions for items requiring ongoing maintenance or service. This combination signals that the payer is emphasizing the necessity of continued service based on the patient's needs and the coverage terms.
Common Scenarios
1A durable medical equipment provider billed for a wheelchair rental and received an adjustment indicating partial payment due to service limitations.
→ The N218 remark code suggests that the payer expects the provider to continue servicing the wheelchair as long as the patient requires it, and it reinforces the need to adhere to the contractual terms regarding coverage for maintenance.
2A home health agency submitted a claim for ongoing therapy visits and received an adjustment indicating that the payment was reduced because the service duration was not clearly defined.
→ With the N218 remark code, the payer is indicating that ongoing therapy services are covered as long as they are necessary for the patient, and it highlights the importance of documenting the patient's continued need.
3A provider billed for an infusion pump and received an adjustment indicating that only a portion of the billed amount was paid due to service limitations outlined in the policy.
→ The N218 remark code points out that the payer will cover maintenance and servicing of the infusion pump as long as the patient needs it, emphasizing the need for compliance with the specified contract terms.
What to Do
- Ensure that ongoing service documentation is in place to support the claim for maintenance and servicing.
- Review the contract terms to confirm the coverage specifics for the item in question.
- Consider submitting additional documentation if the patient's continued need for the item has not been clearly established.
What to Check
- The patient’s medical records to verify the ongoing need for the item or service.
- The provider's contract with the payer to understand the terms for maintenance and servicing coverage.
- The claim adjustment reason code that accompanies the N218 remark for context on the payment adjustment.