N567Remark Code (RARC)Active
N567 Remark Code - Not Covered When Considered Preventative
The N567 remark code indicates that the service billed is not covered by the payer because it is deemed to be preventive in nature. This means that the payer considers the service to fall under their guidelines for preventive care, which may not be reimbursed under the current policy.
How It Relates to the Denial
The N567 remark code typically accompanies adjustment reason codes that indicate a denial based on coverage criteria. This combination signals that the service was reviewed and determined to be preventive, thus leading to the denial of payment.
Common Scenarios
1A provider submits a claim for a routine annual physical exam, billing for specific tests performed during the visit. The remittance advises that the claim was adjusted due to the application of a preventive care policy.
→ The N567 remark code clarifies that the tests performed are not covered because they are considered preventive services, which the payer does not reimburse.
2A claim for a screening mammogram is sent for payment, but the remittance shows an adjustment indicating non-payment. The accompanying remarks include N567.
→ In this case, N567 suggests that the screening mammogram is classified as preventive, and therefore, the payer will not cover the costs associated with it.
3A patient receives a wellness check and related immunizations, and the provider bills for both. The remittance response includes an adjustment with the N567 remark code.
→ The N567 remark indicates that the billed immunizations are considered preventive, leading to the denial of coverage for those specific services.
What to Do
- Review the claim details to confirm the nature of the services billed and determine if they fall under preventive care guidelines.
- Consider re-evaluating the services to see if any components are eligible for coverage outside the preventive designation.
- If applicable, inform the patient about the coverage denial and discuss possible out-of-pocket costs.
What to Check
- The payer's coverage policy for preventive services to understand what is included or excluded.
- The specific services billed on the claim to determine if they align with preventive care definitions.
- Any patient-specific plan documents that outline coverage for preventive services.