N507Remark Code (RARC)Active
N507 Remark Code - Distance Requirements Not Met
The N507 remark code indicates that the plan's distance requirements for a specific service were not fulfilled. This means that the provider may have billed for a service that requires the patient to be within a certain distance from a facility or provider, which was not adhered to in this case.
How It Relates to the Denial
The N507 remark code typically accompanies adjustment reason codes related to service location or provider network restrictions. Its presence suggests that the adjustment made to the claim is due to the patient being outside the required distance from an authorized provider or facility.
Common Scenarios
1A patient received physical therapy services billed by a provider who is located outside the network's designated distance limits. The claim was submitted and returned with a denial adjustment.
→ The N507 remark code points to the failure to meet the distance criteria set by the insurance plan, indicating that the service may not be covered due to the patient's location.
2A claim was submitted for a diagnostic imaging service performed at a facility that is not within the allowable distance from the patient's home as per the plan's policy. The remittance shows an adjustment for this reason.
→ The N507 remark code highlights that the service was denied because the patient did not comply with the plan's distance requirements, signaling the need for a review of location eligibility.
3A patient was referred to a specialist who is located further than the plan's allowable distance from the patient's residence. The claim submitted was adjusted and returned with the N507 remark code.
→ With the N507 remark code, the payer is indicating that the adjustment was made because the specialist's location exceeds the distance limits imposed by the plan.
What to Do
- Verify the patient's address to confirm their distance from the provider or facility.
- Check if there are alternative providers closer to the patient's location that meet the plan's requirements.
- If applicable, consider appealing the decision by providing evidence of the patient's eligibility for the service despite the distance.
What to Check
- The plan's distance requirements for covered services.
- The patient's home address and its distance from the billed provider or facility.
- The adjustment reason code accompanying the N507 to understand the context of the denial.