N937Remark Code (RARC)Active
N937 Remark Code - Service Line Denial Threshold Exceeded
The N937 remark code indicates that the service line denial threshold has been exceeded for the claim. This means that the payer has determined that the number of denied services on this claim surpasses their established limit for processing.
How It Relates to the Denial
The N937 remark code typically accompanies a Claim Adjustment Reason Code that details the specific denial or adjustment. This combination signals that multiple service lines were denied, and the total exceeded the threshold set by the payer.
Common Scenarios
1A claim for multiple physical therapy sessions was submitted, but several lines were denied due to lack of medical necessity. The remittance shows the N937 code along with a reason code for the individual denials.
→ In this case, the N937 remark code indicates that the total number of denied therapy sessions surpassed the payer's threshold for review, leading to a blanket denial of additional services.
2A provider submitted a claim for a series of lab tests, but several were denied based on coding errors. The remittance includes the N937 code along with a general reason code for the denials.
→ Here, the N937 remark code suggests that the cumulative denials from the lab tests exceeded the allowable threshold, indicating that the payer has a policy on the maximum number of denials.
3A claim with multiple surgical procedures was denied for various reasons, and the remittance includes the N937 remark in addition to specific reason codes for each procedure.
→ The presence of the N937 remark code signals that the total number of denials related to the surgical procedures has exceeded the payer's denial threshold, prompting the overall claim denial.
What to Do
- Review the specific Claim Adjustment Reason Code associated with the N937 remark for details on the denied service lines.
- Consider resubmitting the claim with corrected information if applicable, particularly if errors were identified in the denied lines.
What to Check
- The detailed denial report to understand which service lines were denied and why.
- The payer's policy on denial thresholds to determine if the exceeded threshold is consistent with their guidelines.
- The original claim submission to identify any potential errors or issues that led to the denials.