N591Remark Code (RARC)Active
N591 Remark Code - Payment Based on IME or UR
The N591 remark code indicates that the payment amount has been determined based on the findings from an Independent Medical Examination (IME) or a Utilization Review (UR). This code supplements a Claim Adjustment Reason Code, providing further clarification on how the payment was calculated in relation to the examination or review.
How It Relates to the Denial
The N591 remark code typically accompanies adjustment reason codes related to payment reductions or denials stemming from IME or UR assessments. This combination signals that the payer's decision was influenced by an evaluation of medical necessity or appropriateness of the services rendered.
Common Scenarios
1A claim for a physical therapy session was partially paid, and the remittance includes an adjustment reason code indicating a reduction due to medical necessity.
→ The N591 remark code explains that the payment was based on an IME or UR, which assessed the necessity of the physical therapy services and resulted in the adjusted amount.
2An outpatient surgical procedure was billed, but the payment received is less than expected, with a reason code indicating non-coverage based on a review.
→ The appearance of the N591 remark code clarifies that the payment decision was influenced by an IME or UR, suggesting that the services performed were deemed not medically necessary according to the review.
3A claim for diagnostic imaging was submitted and the payment reflected a reduction, accompanied by a reason code for a medical review process.
→ The N591 remark indicates that the payment amount was established following an IME or UR, pointing to the review's impact on the claim's final payment.
What to Do
- Review the accompanying Claim Adjustment Reason Code to understand the specific reason for the payment adjustment.
- Contact the payer for clarification on the findings from the IME or UR if additional detail is needed to address the adjustment.
- If appropriate, consider appealing the decision based on the findings from the IME or UR.
What to Check
- The remittance advice for the accompanying Claim Adjustment Reason Code to assess the nature of the adjustment.
- Any documentation related to the IME or UR that may provide insight into the payer's decision-making process.
- The patient's medical record to verify the services rendered and their necessity as evaluated in the IME or UR.