N792Remark Code (RARC)Active
N792 Remark Code: Incomplete/Invalid History & Physical Report
The N792 remark code indicates that the history and physical report submitted with the claim was either incomplete or invalid. This remark supplements a Claim Adjustment Reason Code that identifies the adjustment made by the payer, providing additional context regarding the documentation requirements.
How It Relates to the Denial
The N792 remark typically accompanies adjustment reason codes related to insufficient documentation or medical necessity. This combination signals that the claim was not processed due to issues with the submitted history and physical report, necessitating further review or correction.
Common Scenarios
1A provider submitted a claim for a surgical procedure, but the accompanying documentation included an incomplete history and physical report.
→ In this case, the N792 remark suggests that the payer could not validate the medical necessity of the procedure due to the lack of required information in the history and physical report.
2A claim for a new patient office visit was denied, with the remittance showing the N792 remark alongside a reason code for insufficient documentation.
→ Here, the N792 indicates that the history and physical report did not meet the payer's standards, which led to the denial of the claim based on the accompanying reason code.
3A claim for a diagnostic test was submitted, but the remittance returned with the N792 remark indicating incomplete documentation was provided.
→ The N792 remark in this scenario highlights that the payer found the history and physical report to be inadequate to support the medical necessity of the test.
What to Do
- Review the history and physical report submitted with the claim for completeness and accuracy.
- Obtain the necessary information or missing sections in the history and physical report and resubmit the claim.
- Ensure that the report meets the payer's specific documentation requirements before re-filing.
What to Check
- The original history and physical report submitted with the claim.
- The claim adjustment reason code that accompanies the N792 remark for additional context.
- The payer's documentation guidelines to ensure compliance with their requirements.