N473Remark Code (RARC)Active
N473 Remark Code - Missing Certification Explained
The N473 remark code indicates that there is a missing certification related to the claim. This remark supplements an adjustment already noted by a Claim Adjustment Reason Code, clarifying that certification documentation was not provided or is insufficient for the billed services.
How It Relates to the Denial
The N473 remark code typically accompanies adjustment reason codes that denote issues with certification requirements. The combination of this remark with the accompanying reason code signals that the claim cannot be processed due to inadequate certification documentation.
Common Scenarios
1A provider billed for a procedure that requires prior authorization but did not submit the necessary certification documentation. The remittance shows an adjustment for this issue.
→ The N473 remark suggests that the payer expects certification documentation to support the claim. Without it, the claim may not be eligible for payment.
2A claim for a durable medical equipment item was submitted, but the necessary certification was missing from the claim submission. The remittance response includes an adjustment and the N473 remark.
→ The presence of the N473 remark indicates that the payer needs the missing certification documentation to proceed with payment on the claim.
3A therapy service was billed, but the claim was denied due to lack of certification. The remittance includes a reason code for denial along with the N473 remark.
→ The N473 remark informs the biller that the denial was specifically due to missing certification, and the claim cannot be reconsidered until the required documentation is submitted.
What to Do
- Gather the necessary certification documentation that supports the claim.
- Ensure that the certification is correctly completed and submitted as required by the payer's guidelines.
- Resubmit the claim with the certification included to facilitate processing.
What to Check
- Review the initial claim submission to confirm what certification was required.
- Check the payer's policy for specific certification requirements for the billed service.
- Look for any previous communications from the payer regarding missing documentation or certification requests.