N374Remark Code (RARC)Active
N374 Remark Code - Medicare Part A Exhausted
The N374 remark code indicates that the primary Medicare Part A insurance has been exhausted, necessitating a Part B Remittance Advice. This information is critical for understanding the billing status, as it highlights the need to transition to Part B coverage for the services rendered.
How It Relates to the Denial
Typically, the N374 remark code accompanies a Claim Adjustment Reason Code that reflects a denial or adjustment based on the exhaustion of Part A benefits. This combination signals to the biller that further action is needed to process the claim under Part B.
Common Scenarios
1A patient received inpatient hospital services, and the claim was billed to Medicare Part A. The remittance advises that the claim is denied due to exhausted benefits.
→ In this scenario, the N374 remark code clarifies that the denial stems from the exhaustion of Part A coverage, indicating that the provider should seek reimbursement from Part B.
2A skilled nursing facility submitted a claim under Medicare Part A for a patient who has reached their benefit limit. The remittance shows an adjustment related to the exhausted benefits.
→ The presence of the N374 remark code informs the facility that they need to obtain a Part B Remittance Advice to continue processing for any remaining applicable services.
3A home health agency billed for services under Medicare Part A, but the remittance indicates an adjustment due to exhausted benefits, along with the N374 remark.
→ Here, the N374 remark code serves to inform the agency that they must look to Part B for potential payment options as the Part A benefits are no longer available.
What to Do
- Request a Part B Remittance Advice from the payer to proceed with billing.
- Verify that all services rendered are eligible for Part B coverage before submitting any further claims.
- Ensure that the claim reflects accurate service dates and codes applicable under Part B.
What to Check
- Review the patient's benefit exhaustion date to confirm Part A coverage limits.
- Check the eligibility response for the patient to ensure they are still enrolled in Part B.
- Examine the original claim submission for compliance with Part B billing requirements.