N358Remark Code (RARC)ActiveInformational Alert
N358 Remark Code - Review Decision with Additional Documentation
The N358 remark code indicates that a decision made by the payer may be subject to review if further documentation is submitted. This alert serves as a notification to the biller that additional supporting information, as outlined in the contract or plan benefit documents, could potentially influence the payer's decision.
What This Alert Tells You
As an informational alert, the N358 remark code is not associated with any specific adjustment or denial. Instead, it suggests that the payer is open to reconsideration of their decision based on the submission of more documentation that complies with the requirements set forth in the relevant contract or benefit documents.
Common Scenarios
1A claim for a surgical procedure was denied due to lack of prior authorization. The remittance advice includes the N358 remark code.
→ In this case, the N358 alert indicates that if the provider can submit the necessary prior authorization documentation, the payer may review the claim decision.
2A claim for a diagnostic test was processed but resulted in a payment less than expected, accompanied by the N358 remark code.
→ Here, the N358 remark suggests that submitting further documentation supporting the medical necessity of the test, as described in the plan benefit documents, might lead to a re-evaluation of the payment amount.
3A claim was denied due to a technical error in the coding, and the remittance includes the N358 alert code.
→ The presence of the N358 remark indicates that if the provider submits corrected coding documentation as per the contract requirements, the payer may reconsider the claim.
What to Do
- Review the contract or plan benefit documents for requirements on additional documentation.
- Prepare and submit the necessary documentation that aligns with the payer's guidelines.
- Do not resubmit the original claim without the requested additional information.
What to Check
- The contract terms regarding documentation for claim review.
- Plan benefit documents that outline the requirements for additional information.
- Any previous correspondence with the payer regarding the claim in question.