N170Remark Code (RARC)Active
N170 Remark Code - Certificate of Medical Necessity Needed
The N170 remark code indicates that a new, revised, or renewed certificate of medical necessity (CMN) is required for the service provided. This remark supplements an adjustment made by a Claim Adjustment Reason Code, clarifying that the lack of a valid CMN is the reason for the adjustment.
How It Relates to the Denial
The N170 remark code typically accompanies adjustment reason codes related to claims that require documentation of medical necessity. The combination signals that the payer is seeking additional proof to support the medical necessity of the billed services.
Common Scenarios
1A claim for durable medical equipment (DME) was submitted, but the remittance indicates a denial due to lack of documentation.
→ The N170 remark suggests that the payer requires a new or updated CMN to validate the necessity of the DME supplied.
2A physical therapy service was billed, and the claim was adjusted indicating insufficient documentation for medical necessity.
→ The presence of the N170 remark indicates that the payer needs an updated certificate of medical necessity to proceed with payment.
3A home health service claim was processed, but the remittance shows an adjustment due to missing documentation.
→ The N170 remark code points to the requirement for a renewed or revised CMN to support the claim's medical necessity.
What to Do
- Obtain a new or updated certificate of medical necessity from the prescribing physician.
- Ensure the CMN is completed accurately and includes all necessary details about the patient's condition and treatment.
- Submit the revised CMN along with the claim for reconsideration.
What to Check
- Review the previous certificate of medical necessity for expiration or completeness.
- Check the claim documentation to confirm that the original CMN was included.
- Verify the payer's specific requirements for the CMN to ensure compliance.