N773Remark Code (RARC)Active
N773 Remark Code: Drug Not From Specialty Vendor
The N773 remark code indicates that the drug supplied was not obtained from a specialty vendor, which is likely a requirement for reimbursement. This remark typically appears alongside a claim adjustment reason code that explains the financial impact of this issue on the claim. The payer expects that specialty drugs be sourced from designated vendors to qualify for coverage or proper reimbursement.
How It Relates to the Denial
This remark code often accompanies adjustment reason codes related to denied or reduced payments for specialty drugs. Together, they signal that the claim is being affected due to non-compliance with vendor sourcing requirements for specialty medications.
Common Scenarios
1A claim for a specialty drug was submitted, but the remittance shows the N773 remark code along with a denial reason code for payment reduction.
→ In this case, the N773 remark code points to the fact that the drug was not sourced from an approved specialty vendor, which likely led to the denial or adjustment in payment.
2A pharmacy billed for a high-cost specialty medication, but the payment was adjusted due to the N773 remark appearing on the remittance advice.
→ The N773 remark indicates that the payer did not recognize the drug as eligible for reimbursement because it was not obtained from a specialty vendor, as required for coverage.
3A healthcare provider submitted a claim for a patient who received an infusion of a specialty drug, but the remittance returned with the N773 remark code.
→ The presence of the N773 remark suggests that the drug administered was not procured from the necessary specialty vendor, impacting the payment outcome.
What to Do
- Verify the source of the drug supplied to ensure it was obtained from a specialty vendor.
- If the drug was not sourced from a specialty vendor, check the patient's plan benefits to understand coverage implications.
- Consider resubmitting the claim with documentation showing the drug was obtained from the appropriate vendor, if applicable.
What to Check
- Review the vendor designation requirements in the patient's insurance policy.
- Check the claim submission details to confirm the source of the drug supplied.
- Consult the payer's policy on specialty drug sourcing to ensure compliance.