N138Remark Code (RARC)ActiveInformational Alert
N138 Remark Code: Dental Advisor Review Alert
The N138 alert informs providers that if they disagree with the opinion of the Dental Advisor, they can submit additional information, such as radiographs, for a second review. This process allows for further evaluation of the case by the Dental Advisor Unit at the subscriber's dental insurance carrier.
What This Alert Tells You
The N138 alert is not associated with any specific adjustments or reason codes; it serves as a notification for providers regarding the process for seeking a second opinion from the Dental Advisor. It is intended to ensure providers are aware of their options when they have conflicting information.
Common Scenarios
1A dental provider received a denial for a procedure based on the Dental Advisor's initial assessment. The provider believes the assessment was incorrect due to missing radiographs.
→ The N138 alert indicates that the provider can submit the relevant radiographs to the Dental Advisor Unit for a second review, potentially leading to a different outcome.
2A dentist disagrees with the treatment recommendation made by the Dental Advisor after a claim was processed. They have additional clinical data to support their position.
→ The N138 alert suggests that the dentist can send this additional information to the Dental Advisor Unit for an independent review, which may alter the original decision.
3An orthodontist's claim was reviewed by the Dental Advisor, resulting in a denial based on the submitted documentation. The orthodontist has further imaging that they believe supports their case.
→ With the N138 alert, the orthodontist is informed that they may submit the new imaging to the Dental Advisor Unit for a second opinion, allowing for a reconsideration of the claim.
What to Do
- Do not resubmit the claim without additional information.
- Prepare the necessary radiographs or data you believe support your case for submission.
What to Check
- Review the initial opinion provided by the Dental Advisor.
- Check the claim documentation to identify what information was included initially.
- Gather any additional radiographs or clinical data that may support your disagreement with the Dental Advisor's opinion.