N674Remark Code (RARC)Active
N674 Remark Code - Not Covered Without Prerequisite Service
The N674 remark code indicates that the billed service is not covered unless a prerequisite procedure or service has been performed. This suggests that the payer requires a specific prior service to be completed before they will reimburse for the current claim.
How It Relates to the Denial
N674 typically accompanies a claim adjustment reason code that indicates a denial due to lack of coverage. This combination signals to the biller that the denial is based on the absence of required prior services.
Common Scenarios
1A provider billed for a follow-up treatment after a surgery, but the payer returned a denial indicating that the procedure is not covered.
→ The N674 remark code is pointing out that the follow-up treatment is not eligible for coverage until the surgical procedure has been documented as completed.
2A claim for physical therapy was submitted, but the remittance showed a denial indicating the service is not covered.
→ In this case, N674 indicates that the physical therapy is contingent upon a prior evaluation or treatment being performed first.
3A patient received a diagnostic test without first obtaining a required referral, leading to a denial from the payer.
→ The N674 remark informs the biller that the diagnostic test is not covered since the prerequisite referral was not obtained prior to the service.
What to Do
- Verify that the prerequisite procedure/service has been performed and documented.
- Resubmit the claim with the necessary documentation if the prerequisite is met.
- Ensure any prior authorization requirements are satisfied before resubmitting.
What to Check
- The patient's medical records to confirm completion of the prerequisite service.
- The claim submission details to ensure accurate coding and documentation of the prior service.
- Payer guidelines regarding prerequisite services for the specific procedure billed.