N213Remark Code (RARC)Active
N213 Remark Code - Missing DRG Information Explained
The N213 remark code indicates that there is missing, incomplete, or invalid information regarding the facility or discrete unit's Diagnosis-Related Group (DRG) or DRG exempt status. This remark supplements an existing Claim Adjustment Reason Code by providing specific details about the nature of the discrepancy in the DRG information provided with the claim.
How It Relates to the Denial
The N213 code typically accompanies adjustment reason codes related to DRG payments or denials. When you see N213, it signals that the payer has identified issues with the DRG data that needs to be addressed to process the claim correctly.
Common Scenarios
1A hospital billed for an inpatient service using a DRG code, but the payment was reduced due to a claim adjustment reason code regarding DRG validation.
→ The N213 remark indicates that the payer found the DRG information to be missing or invalid, and this is why the adjustment was made. You need to verify the accuracy of the DRG data submitted.
2A claim for a surgical procedure was submitted with a DRG, but the remittance shows a denial with a claim adjustment reason code and the N213 remark.
→ This remark suggests that the payer requires more complete or correct DRG information to proceed with payment. Review the DRG details for completeness and accuracy.
3An outpatient facility submitted a claim that included DRG exempt status, but the payment was denied with a claim adjustment reason code and the N213 remark attached.
→ The N213 remark implies that the DRG exempt status information provided is either missing or incorrect, leading to the denial. Double-check the exempt status details against payer requirements.
What to Do
- Verify the facility's DRG or DRG exempt status information submitted with the claim.
- Correct any inaccuracies in the DRG data and resubmit the claim if necessary.
- Ensure all required documentation supporting the DRG information is included with the claim.
What to Check
- The claim documentation for the correct DRG or DRG exempt status information.
- The facility's records to confirm the accuracy of the DRG codes used on the claim.
- Any communication from the payer that outlines the specific DRG requirements.