N245Remark Code (RARC)Active
N245 Remark Code - Incomplete/Invalid Plan Information
The N245 remark code indicates that the claim has incomplete or invalid plan information for other insurance. This remark supplements a Claim Adjustment Reason Code that has already described an adjustment related to the claim, providing clarity on the specific issue concerning other insurance coverage.
How It Relates to the Denial
The N245 remark code typically accompanies adjustment reason codes that signal a denial or reduction due to issues with other insurance information. This combination suggests that the payer requires accurate and complete details regarding any other insurance plans before proceeding with payment.
Common Scenarios
1A provider submits a claim for a patient with multiple insurance plans, but the remittance shows a denial due to insufficient information about the secondary insurance.
→ In this case, the N245 remark code points to the need for more detailed or valid information regarding the patient's other insurance. The payer expects the provider to verify and correct the insurance details.
2A claim for a surgical procedure is submitted, but the payer issues a partial payment and includes a reason code indicating the need for further insurance details.
→ Here, the N245 remark code indicates that the payer needs complete information about other insurance coverage to process the claim fully. The provider should review the patient's insurance records.
3A claim is submitted for an outpatient service, and the remittance advises a reduction in payment due to issues with the reported other insurance plan.
→ The presence of the N245 remark code suggests that the payer found the information on the other insurance insufficient or invalid, and further clarification is required to resolve the payment issue.
What to Do
- Verify the patient's other insurance details for accuracy and completeness.
- Correct any inaccuracies in the reported insurance information before resubmitting the claim.
- Ensure that all necessary documentation regarding the other insurance is included with the claim.
What to Check
- The patient's insurance policy documents for completeness and accuracy.
- The claim submission details, focusing on the fields that report other insurance information.
- Any previous correspondence or remittance advice regarding the same issue for additional context.