N612Remark Code (RARC)Active
N612 Remark Code - Provider Not Authorized for Treatment
The N612 remark code indicates that the medical provider is not authorized or certified to treat injured workers in the specified jurisdiction. This usually means that the payer has determined the provider lacks the necessary credentials or permissions required by local regulations for workers' compensation cases.
How It Relates to the Denial
The N612 remark typically accompanies Claim Adjustment Reason Codes related to provider eligibility or authorization issues. The combination signals that the claim has been denied or adjusted due to the provider's lack of certification for treating injured workers in that particular area.
Common Scenarios
1A physical therapy provider submitted a claim for treatment of a worker's compensation case. The remittance returned with an adjustment indicating the claim was denied due to authorization issues.
→ The N612 remark informs the billing office that the provider is not certified to treat injured workers in the jurisdiction, suggesting that the claim denial is based on provider eligibility.
2A chiropractor billed for services rendered to an injured worker, but the payment was denied with an accompanying reason code regarding provider authorization.
→ With the N612 remark present, the billing team should recognize that the denial stems from the chiropractor's lack of authorization or certification for treating workers' compensation cases in that location.
3A hospital submitted a claim for emergency services provided to an injured worker, and the remittance indicated a denial with a note about provider certification.
→ The presence of the N612 remark indicates that the hospital is not authorized to provide those services within the workers' compensation framework of the jurisdiction, leading to the claim denial.
What to Do
- Verify the provider's certification status for treating injured workers in the relevant jurisdiction.
- Consider referring the patient to a certified provider if necessary.
- If applicable, appeal the decision with proof of the provider's authorization.
What to Check
- The provider's credentials and certification documentation.
- The state or jurisdiction's requirements for treating injured workers.
- The specific claim adjustment reason code that accompanies the N612 remark.