N92Remark Code (RARC)Active
N92 Remark Code - Facility Not Certified for Digital Mammography
The N92 remark code indicates that the facility where the service was performed is not certified for digital mammography. This means that the payer is informing the biller that the claim may have been denied or adjusted because the provider does not meet the necessary certification requirements for this specific service.
How It Relates to the Denial
The N92 remark code typically accompanies a Claim Adjustment Reason Code related to non-coverage or denial of a claim for digital mammography services. The combination signals that the claim was processed but not paid due to certification issues at the facility.
Common Scenarios
1A claim for a digital mammography service performed at a local clinic is submitted, but the payer returns it with an adjustment indicating denial.
→ The N92 remark code suggests that the clinic is not certified to perform digital mammography, which is why the claim was not reimbursed.
2A provider bills for a digital mammogram and receives a remittance with an adjustment for non-coverage.
→ The presence of the N92 remark code indicates that the facility's lack of certification is the reason for the denial, and the payer expects this issue to be addressed.
3A healthcare facility submits a claim for digital mammography, and the remittance indicates an adjustment due to a facility certification issue.
→ The N92 remark code clarifies that the adjustment is due to the facility not being certified for digital mammography, impacting the claim's payment.
What to Do
- Verify the facility's certification status for digital mammography.
- Consider contacting the facility to obtain proof of certification or to discuss the billing issue.
- If the facility is indeed not certified, advise the patient regarding alternative locations for receiving digital mammography services.
What to Check
- The facility's credentialing documents to confirm certification for digital mammography.
- The claim submission details to ensure the correct facility was billed.
- Any prior communications with the payer regarding facility certifications.