N95Remark Code (RARC)Active
N95 Remark Code - Provider Type Restrictions
The N95 remark code indicates that the provider type or specialty billed is not permitted to charge for the service rendered. This is a clarification that supplements a related Claim Adjustment Reason Code, reinforcing that the service is not covered due to provider type restrictions.
How It Relates to the Denial
The N95 remark code typically accompanies reason codes that denote service non-coverage based on provider qualifications. This combination signals that the adjustment relates to the billing limitations imposed on certain provider types or specialties.
Common Scenarios
1A physical therapist submits a claim for a diagnostic imaging service, and the remittance shows a denial with the accompanying reason code indicating non-coverage.
→ The N95 remark code clarifies that the physical therapist's specialty does not allow billing for imaging services, confirming the denial is valid based on provider type.
2An outpatient clinic bills for a surgical procedure performed by a nurse practitioner, but the claim is denied with a reason code regarding provider qualifications.
→ The N95 remark code indicates that the nurse practitioner's provider type cannot bill for surgical services, reinforcing the reason for the adjustment.
3A chiropractor submits a claim for a mental health service, and the remittance includes a reason code for non-coverage based on provider specialty.
→ The N95 remark code specifies that chiropractors are not authorized to bill for mental health services, validating the payer's adjustment.
What to Do
- Review the Claim Adjustment Reason Code that accompanies N95 to understand the specific service denial.
- Confirm whether the provider's specialty aligns with the services billed. If not, consider correcting the claim or advising the provider.
What to Check
- The provider's specialty designation in the claims system.
- The payer's guidelines regarding service coverage for different provider types.
- The specific service billed to ensure it complies with the provider's allowed services.