N372Remark Code (RARC)Active
N372 Remark Code - Maintenance Charges Coverage
The N372 remark code indicates that the payer only covers maintenance or service charges deemed reasonable and necessary. This remark supplements an adjustment already communicated by an accompanying reason code, clarifying the limits of coverage for the billed services.
How It Relates to the Denial
N372 typically accompanies claim adjustment reason codes that indicate a denial or reduction in payment due to charges considered excessive or not justified. The combination signals that the payer has evaluated the billed services against their coverage criteria for maintenance or service charges.
Common Scenarios
1A provider submitted a claim for maintenance charges related to equipment servicing. The remittance received included a denial for the majority of the charges.
→ The N372 remark suggests that while some maintenance charges may be covered, the payer determined that the charges submitted exceeded what they consider reasonable and necessary.
2A facility billed for ongoing service fees for a medical device. The claim adjustment reason code indicated a partial payment, and N372 appeared on the remittance.
→ Here, N372 is clarifying that only the reasonable and necessary service fees were approved, implying that some charges were not deemed essential by the payer.
3A claim for routine maintenance on a piece of medical equipment was submitted, but the remittance showed an adjustment with N372 included.
→ The presence of N372 indicates that the payer evaluated the maintenance charges and determined that only portions of them were reasonable and necessary for coverage.
What to Do
- Review the billed charges to identify which were deemed unreasonable or unnecessary by the payer.
- Adjust the claim to reflect only the reasonable maintenance/service charges before resubmitting, if applicable.
What to Check
- The original claim submission to verify the specific maintenance/service charges billed.
- The payer's policy documents regarding coverage limits for maintenance and service charges.
- The accompanying reason code on the remittance to understand the context of the adjustment.