N139Remark Code (RARC)ActiveInformational Alert
N139 Remark Code - Appeal Process for Non-Participating Providers
The N139 code serves as an alert indicating that, according to 32 CFR 199.13, a non-participating provider cannot appeal a determination on their own. Instead, if there is a disagreement with the Dental Advisor's opinion, the beneficiary must appoint someone in writing to act as their representative for the appeal process.
What This Alert Tells You
This alert is intended for situations where a non-participating provider has received a determination they wish to contest, but it clarifies that they cannot initiate the appeal themselves. It typically accompanies information about how to properly appoint a representative for appeals related to dental claims.
Common Scenarios
1A non-participating dental provider received a claim denial and wants to appeal the decision made by the Dental Advisor.
→ The N139 alert indicates that the provider cannot appeal this determination directly and must instead have the beneficiary appoint them as a representative to proceed.
2A claim was submitted by a non-participating provider, and the payer's response includes the N139 alert regarding the appeal process.
→ This alert informs the provider that they cannot contest the decision independently and must wait for the beneficiary to initiate the appeal by designating them as a representative.
3A patient disagreed with a dental treatment decision made by their insurance and contacted their provider for assistance in appealing.
→ The N139 alert indicates that the provider can assist in the appeal process only if the patient formally appoints them as a representative, as outlined in the alert.
What to Do
- Do not attempt to appeal the determination as a non-participating provider.
- Ensure the beneficiary understands the need to appoint a representative in writing if they wish to appeal.
What to Check
- Review the written appointment letter from the beneficiary designating the provider as their representative.
- Check the signed statement from the beneficiary explaining the disagreement with the Dental Advisor's opinion.
- Gather any relevant radiographs and documentation that support the appeal to accompany the appointment letter.