N414Remark Code (RARC)Active
N414 Remark Code - Service Frequency Limit Explained
The N414 remark code indicates that the billed service has a frequency limit, specifically that it is allowed only four times within a 12-month period. This is a limitation set by the payer, which affects reimbursement for the service if the limit is exceeded.
How It Relates to the Denial
N414 typically accompanies a Claim Adjustment Reason Code that indicates a denial or adjustment due to exceeding the allowed frequency for a service. The combination signals that the service was billed more times than permitted within the specified timeframe.
Common Scenarios
1A patient received physical therapy services, and the provider billed for five sessions within a year. The remittance shows a denial for the fifth session.
→ The N414 remark code clarifies that the payer allows only four physical therapy sessions in a 12-month period, which is why the fifth was denied.
2A claim for a diagnostic imaging service was submitted, but the remittance advises that the service was billed six times in one year, leading to an adjustment.
→ The presence of N414 indicates that the service has a limit of four occurrences per year, explaining the adjustment made to the claim.
3A patient received vaccinations that were billed multiple times in the same year, and the remittance advises on a reduction for the last two doses.
→ The N414 remark suggests that the vaccinations are restricted to four doses in a 12-month period, hence the reduction in payment for the excess doses.
What to Do
- Review the number of times the service was billed within the 12-month period.
- Adjust future claim submissions to comply with the service frequency limit of four times per year.
- Consider communicating with the patient regarding the frequency limitations on their services.
What to Check
- The billing history for the patient to confirm the number of times the service was billed.
- The payer's policy or guidelines regarding frequency limits for the specific service.
- The claim adjustment reason code associated with the N414 remark for further details on the adjustment.