N362Remark Code (RARC)Active
N362 Remark Code - Days or Units Exceed Maximum
The N362 remark code indicates that the billed number of days or units of service has surpassed the payer's allowable maximum. This remark supplements a Claim Adjustment Reason Code, providing further clarification for the adjustment made on the claim.
How It Relates to the Denial
N362 typically accompanies adjustment reason codes that relate to service limits, indicating that the billed quantity exceeded the payer's established thresholds. The combination of these codes signals that the claim has been partially denied due to excess units or days of service.
Common Scenarios
1A provider submits a claim for 15 physical therapy sessions for a patient, but the remittance shows an adjustment for excessive units.
→ In this case, N362 indicates the payer has determined that only a maximum of 12 sessions is covered under the plan, thus denying the additional sessions.
2A claim for 30 days of skilled nursing facility care is submitted, but the remittance indicates an adjustment for exceeding service limits.
→ Here, N362 suggests that the payer allows only 20 days of coverage, leading to a denial of the additional 10 days billed.
3A facility bills for 25 units of a specific procedure, but the remittance returns an adjustment indicating the number of units exceeds allowable limits.
→ The presence of N362 means the payer has set a maximum of 20 units for that procedure, resulting in the denial of the extra units.
What to Do
- Review the total number of days or units billed on the claim.
- Adjust the billing to reflect the maximum allowable days or units as per the payer's policy.
- Consider resubmitting the claim with the corrected quantity if applicable.
What to Check
- The payer's policy on maximum allowable days or units for the billed service.
- The claim adjustment reason code that accompanies N362 for further context.
- Any relevant documentation or notes regarding service limits for the specific procedure or service.