N728Remark Code (RARC)Active
N728 Remark Code - Workers' Compensation Responsibility
The N728 remark code indicates that a workers' compensation insurer has ongoing responsibility for medical services related to the diagnosis in question. This means that the payer is signaling that they will not cover the claim because the workers' compensation insurer is expected to manage these medical costs.
How It Relates to the Denial
The N728 remark typically accompanies adjustments related to denied claims where the primary responsibility lies with a workers' compensation insurer. It clarifies that the reason for denial is due to the ongoing responsibility of the workers' compensation insurer for the specified diagnosis.
Common Scenarios
1A provider submits a claim for a physical therapy session related to a workplace injury. The claim is returned with a denial adjustment indicating that the workers' compensation insurance is responsible.
→ In this case, the N728 remark suggests that the payer is denying the claim because the workers' compensation insurer has ongoing responsibility for the treatment associated with the injury.
2A physician bills for a surgical procedure that is connected to a patient's work-related injury. The remittance advises that the claim cannot be processed due to workers' compensation involvement.
→ Here, the N728 remark points to the fact that the workers' compensation insurer is liable for the costs, and the payer will not reimburse until the workers' compensation claim is resolved.
3A hospital submits a claim for an emergency room visit due to an injury sustained at work. The claim denial includes a remark indicating the workers' compensation insurer's responsibility.
→ The N728 remark reveals that the emergency services provided fall under the purview of the workers' compensation insurer, which is expected to cover the medical expenses.
What to Do
- Verify if the patient has an active workers' compensation claim for the diagnosis in question.
- Contact the workers' compensation insurer to confirm their responsibility for the medical services provided.
- Do not resubmit the claim to the original payer until the workers' compensation insurer has processed the claim.
What to Check
- The patient's claim history to see if a workers' compensation claim exists.
- Documentation from the workers' compensation insurer regarding ongoing responsibility for the treatment.
- The diagnosis and procedure codes on the claim to ensure they align with the workers' compensation claim.