N197Remark Code (RARC)Active
N197 Remark Code: Update Insurance Info Required
The N197 code indicates that the subscriber must provide updated insurance information directly to the payer. This remark is supplemental to an adjustment already noted by a Claim Adjustment Reason Code, highlighting the need for the subscriber's action regarding their insurance details.
How It Relates to the Denial
The N197 remark typically accompanies adjustment reason codes that indicate an issue with the subscriber's insurance information. Together, they signal that the claim cannot be processed correctly until the subscriber resolves this issue by updating their information with the payer.
Common Scenarios
1A claim was submitted for a procedure, but the payment was denied due to outdated subscriber information. The remittance included a reason code indicating the denial and also displayed the N197 remark.
→ In this case, the N197 remark is informing the billing office that the denial is directly related to the need for the subscriber to update their insurance information with the payer.
2A provider billed for a service, but reimbursement was reduced because the payer noted an inconsistency with the subscriber's insurance details. The remittance shows an adjustment reason code along with the N197 remark.
→ The N197 remark suggests that the billing office should inform the subscriber to contact the payer to correct their insurance information before any further claims can be processed.
3A claim for a routine check-up was partially paid, but the remittance advised that further payment is on hold pending an update to the subscriber's insurance. The N197 remark appeared alongside the adjustment reason code for partial payment.
→ This indicates that the payer is awaiting updated insurance information from the subscriber, and the billing office should ensure the subscriber is aware of this requirement.
What to Do
- Inform the subscriber that they need to update their insurance information directly with the payer.
- Do not resubmit the claim until the subscriber has confirmed their insurance details are updated.
What to Check
- The claim adjustment reason code that accompanies the N197 remark for context on the payment issue.
- Any previous correspondence with the subscriber regarding their insurance information.
- The eligibility response from the payer to verify current insurance details.