N516Remark Code (RARC)Active
N516 Remark Code - NPI and EIN Mismatch Explanation
The N516 remark code indicates that there is a discrepancy between the National Provider Identifier (NPI) and the Employer Identification Number (EIN) submitted on the claim. This remark supplements a Claim Adjustment Reason Code related to the same issue, providing additional context about the mismatch.
How It Relates to the Denial
The N516 remark typically accompanies adjustment reason codes that address incorrect or mismatched provider identifiers. This combination signals that the payer has identified a conflict between the NPI and EIN, which must be resolved for proper processing.
Common Scenarios
1A claim was submitted for a physician's service using an NPI for a provider, but the accompanying EIN does not match the records associated with that NPI. The remittance advice returns a denial with an adjustment reason code and the N516 remark.
→ In this case, the N516 remark indicates that the payer has identified a mismatch, and they expect clarification or correction regarding the provider identifiers submitted.
2A facility billed for services using its NPI, but the EIN provided in the claim does not correspond with the registered EIN for that NPI. The remittance includes a reason code for denial along with the N516 remark.
→ Here, the N516 remark serves to highlight that the payer has detected an inconsistency between the submitted identifiers, prompting the need for correction to proceed with payment.
3A claim for a specialty service was submitted with a provider's NPI and EIN, but the remittance advice indicates a denial due to a mismatch, showing the N516 remark alongside a reason code for incorrect information.
→ The N516 remark clarifies that the payer is pointing out the specific issue of mismatched identifiers, which must be addressed before the claim can be reprocessed.
What to Do
- Verify the NPI and EIN submitted on the claim for accuracy and consistency.
- Correct any discrepancies between the NPI and EIN based on the provider's records.
- Resubmit the claim with the updated information to ensure proper processing.
What to Check
- The claim submitted to ensure the NPI and EIN are correctly entered.
- The provider's registration records to confirm the correct NPI and EIN association.
- Any previous communications from the payer regarding provider identifier issues.