N78Remark Code (RARC)Active
N78 Remark Code - EPSDT Components Not Completed
The N78 remark code indicates that the necessary components of the child and teen checkup, also known as EPSDT (Early and Periodic Screening, Diagnostic and Treatment), were not completed. This remark supplements an adjustment reason code, clarifying that the claim was denied due to incomplete services related to the EPSDT requirements.
How It Relates to the Denial
The N78 remark typically accompanies adjustment reason codes that indicate a denial or reduction in payment based on the failure to meet specific service requirements. Together, they signal that the claim could not be fully processed due to missing components in the required checkup.
Common Scenarios
1A provider submitted a claim for a child's annual EPSDT exam but received a denial stating that not all necessary components were completed.
→ The N78 remark code suggests that some aspects of the EPSDT checkup were not performed or documented, leading to the denial of the claim.
2A pediatrician billed for a teen's preventive visit but the remittance report included N78 alongside a reduction in payment for not meeting EPSDT criteria.
→ In this case, the N78 remark indicates that the visit did not fulfill all required elements of the EPSDT, resulting in a payment adjustment.
3A facility submitted claims for multiple child checkups but received an N78 remark on several claims, indicating issues with the service delivery.
→ The presence of the N78 remark implies that those checkups did not include all necessary components as defined by EPSDT guidelines, affecting reimbursement.
What to Do
- Review the specific components of the EPSDT that were required for the checkup.
- Ensure all necessary services were performed and documented in the patient's record.
- If applicable, consider resubmitting the claim with the missing components included.
What to Check
- The patient's medical record for documentation of all EPSDT components.
- The claim submitted to verify which services were billed.
- Payer guidelines on EPSDT requirements to ensure compliance with their standards.