N592Remark Code (RARC)Active
N592 Remark Code - Prescription Adjustment Explained
The N592 remark code indicates that an adjustment has been made because the claim is either not the initial prescription or it exceeds the allowable amount for the initial prescription. This remark serves to clarify the reason behind the adjustment detailed by the accompanying reason code.
How It Relates to the Denial
The N592 remark typically accompanies adjustment reason codes related to prescription claims. The combination signals that issues with initial prescriptions or allowed amounts are the basis for the adjustment.
Common Scenarios
1A pharmacy submitted a claim for a medication refill, but the payer processed it with an adjustment indicating it was not the initial prescription.
→ The N592 remark clarifies that the adjustment is due to the claim being for a refill rather than the initial prescription.
2A provider billed for a prescription that exceeds the amount allowed for the initial prescription, and the claim was adjusted accordingly.
→ The presence of the N592 remark indicates that the payer is highlighting that the billed amount surpasses what is permitted for the initial fill.
3A member was prescribed a medication, but the claim submitted for a subsequent fill was denied with an adjustment reason code, followed by the N592 remark.
→ In this case, N592 points out that the claim involved was not for the initial prescription, leading to the adjustment.
What to Do
- Review the details of the initial prescription to confirm whether the claim submitted is indeed a refill or follow-up.
- Ensure that the billed amount does not exceed the limits set for the initial prescription; if it does, consider adjusting the claim accordingly.
What to Check
- The original prescription document to verify if the claim is for the initial fill or a refill.
- The payer's policy on prescription limits to understand the allowable amounts for initial prescriptions.
- The claim adjustment reason code that accompanies N592 to get context on the adjustment made.