N375Remark Code (RARC)Active
N375 Remark Code - Dependent Eligibility Information Required
The N375 remark code indicates that there is missing, incomplete, or invalid information necessary to determine dependent eligibility for the billed service. This remark supplements a Claim Adjustment Reason Code that provides additional context regarding the denial or adjustment related to dependent eligibility inquiries.
How It Relates to the Denial
The N375 remark typically accompanies reason codes that address eligibility concerns, specifically those indicating that additional information is required to verify a dependent’s eligibility status. Together, they signal that the claim cannot be processed until the necessary information is provided.
Common Scenarios
1A claim for a dependent's medical service was submitted, but the remittance advice returned with a denial stating dependent eligibility was not confirmed.
→ The N375 remark suggests that the payer needs more information to verify the dependent's eligibility, pointing to a lack of required documentation or questionnaire completion.
2A provider billed for a procedure performed on a dependent, and the remittance included a reason code indicating the dependent was not eligible for coverage.
→ The presence of the N375 remark indicates that the payer requires additional information or clarification to confirm the dependent's eligibility, which may include a completed questionnaire.
3An insurance claim for a family member was denied due to eligibility issues, and the remittance included an adjustment reason code for dependent eligibility.
→ The N375 remark reinforces the need for specific information regarding the dependent’s eligibility, indicating that the claim cannot be processed without this data.
What to Do
- Review the claim for any missing dependent information or questionnaires that may need to be completed.
- Contact the patient or policyholder to gather necessary documentation to confirm dependent eligibility.
- Ensure that any previously submitted information is complete and valid before resubmitting the claim.
What to Check
- The eligibility documentation for the dependent in question.
- Any completed questionnaires that may have been submitted with the initial claim.
- The adjustment reason code provided alongside the N375 remark for additional context on the denial.