N411Remark Code (RARC)Active
N411 Remark Code - One Time Service Limit
The N411 remark code indicates that the billed service has been allowed only once within a six-month timeframe. This means that any subsequent claims for the same service within that period will not be covered by the payer, as they are considered duplicates based on the frequency allowed.
How It Relates to the Denial
The N411 remark typically accompanies a Claim Adjustment Reason Code that indicates a denial or adjustment due to frequency limitations. Together, they signal to the biller that the service billed exceeds the allowed frequency set by the payer's policy.
Common Scenarios
1A provider billed for a physical therapy session on March 1, 2023, and then billed again for the same service on June 15, 2023. The remittance returned with the N411 remark code.
→ In this case, the N411 remark indicates that the second claim is being denied because the service was already utilized within the allowed six-month period.
2An office visit was billed on January 5, 2023, and the same office visit was submitted again on July 10, 2023. The remittance included the N411 remark code along with a denial reason code.
→ The N411 remark here points out that the office visit cannot be reimbursed again within six months of the prior visit, indicating a frequency limitation imposed by the payer.
3A patient received a specific diagnostic test on April 20, 2023, and another claim for the same test was submitted on October 1, 2023. The remittance returned with the N411 remark code.
→ The appearance of the N411 remark code suggests that the test has a six-month limit, and the second claim is not eligible for payment.
What to Do
- Review the service frequency policy for the specific service to confirm the six-month limitation.
- Consider if the claim can be adjusted to reflect a different service or visit that is allowed within the timeframe.
- If applicable, inform the patient about the frequency limitation and the reason for the denial.
What to Check
- The claim history for the patient to verify dates of prior services.
- The payer's policy document regarding service frequency limitations.
- The specific service codes billed to ensure they match the frequency restriction described by the N411 remark.