N238Remark Code (RARC)Active
N238 Remark Code - Incomplete Physician Plan of Care
The N238 remark code indicates that the physician certified plan of care submitted with the claim is either incomplete or invalid. This remark often accompanies a claim adjustment reason code that specifies the nature of the adjustment related to the insufficient plan of care documentation.
How It Relates to the Denial
N238 typically appears alongside claim adjustment reason codes that deal with documentation issues or lack of required information. The combination signals that the payer found the submitted plan of care inadequate for processing the claim.
Common Scenarios
1A provider submitted a claim for physical therapy services, but the remittance returned with a claim adjustment reason code indicating insufficient documentation.
→ The N238 remark code suggests that the physician certified plan of care was not properly completed or was missing required elements, leading to the claim's denial.
2A hospital submitted a claim for a home health service, but the remittance advised that the physician's plan of care was invalid.
→ With N238 present, it points to issues with the plan of care, implying the need for correct certification from the physician to support the claim.
3A claim for outpatient services was denied, and the remittance included a reason code for lack of medical necessity along with the N238 remark.
→ The N238 indicates that not only was there a question of medical necessity, but the plan of care documentation was also inadequate, further complicating the claim.
What to Do
- Review the physician certified plan of care for completeness and validity.
- Obtain the necessary signatures or certifications from the physician if missing or incorrect.
- Resubmit the claim with the corrected plan of care documentation.
What to Check
- The submitted physician certified plan of care for required elements.
- Any accompanying documentation that supports the services rendered.
- The claim adjustment reason code that accompanies N238 for further details on the adjustment.