N397Remark Code (RARC)Active
N397 Remark Code - Benefits Not Available for Incomplete Services
The N397 remark code indicates that benefits are not available because the services billed were incomplete or the items were undelivered. This remark supplements the information provided by the accompanying claim adjustment reason code, clarifying why the claim was not fully paid or denied.
How It Relates to the Denial
Typically, the N397 remark accompanies claim adjustment reason codes that denote a reduction in payment due to incomplete services or undelivered items. This combination signals that the payer is unable to provide payment for services not fully rendered or items not received by the patient.
Common Scenarios
1A provider submitted a claim for a surgical procedure but billed for post-operative care that was not completed due to complications.
→ The N397 remark suggests that the post-operative services claimed were deemed incomplete, leading to a denial of benefits for those services.
2A claim was submitted for durable medical equipment (DME) that was partially delivered, with some items still pending delivery.
→ The presence of the N397 remark indicates that benefits for the undelivered items are not available, impacting the overall payment for the claim.
3A healthcare provider billed for physical therapy sessions, but only some sessions were provided due to patient cancellation.
→ The N397 remark points out that benefits are unavailable for the incomplete services, suggesting that the claim should reflect only the sessions that were actually rendered.
What to Do
- Review the services or items billed to identify which were incomplete or undelivered.
- Adjust the claim to reflect only the services or items that were fully rendered to ensure appropriate payment.
- Consider resubmitting the claim with the correct information if services were mistakenly billed as complete.
What to Check
- The claim details to confirm which services were completed and which were not.
- Documentation of service delivery to validate what was provided versus what was billed.
- The accompanying reason code on the remittance to understand the primary reason for the adjustment.