Wiki n684 payment denied

[Keating.angie@gmail.com]

Can anyone tell me what this means:
n684 Payment denied as this is a specialty claim submitted as a general claim?
This has been the response several times, but I'm unsure what I need to do. I work in a chiropractor's office.

Thanks,
Angie

 

[dclark7]

We would need more information. This is a remittance advise remark code and should have been paired with a claim adjustment reason code, what code was it paired with? Were any other remittance advise remark codes used with this? What codes were billed? Did you verify that your provider can actually bill the codes that were used?

 

[Keating.angie@gmail.com]

Code 98941 3 to 4 spinal manipulation, which we can bill. Two more adjust reason codes of PR-96 and N130

 

[runninghonu@yahoo.com]

PR-96 is pt responsibility - not a covered benefit
I believe N130 means it is not part of the pt's insurance benefit package.

 

[dclark7]

As Heather stated PR is patient responsibility and CARC 96 is non-covered charges. RARC N130 says "consult plan benefit documents/guidelines for information about restrictions for this service"

So it would be safe to say that these are not covered by the patient's insurance and since the insurance made it the patient's responsibility you can bill them.

Here is the link to the Washington Publishing Company, you can find all the remark code definitions at this site. http://www.wpc-edi.com/reference/

 

[Keating.angie@gmail.com]

So why does it state that it is a specialty claim submitted as a general claim?

 

[dclark7]

I wouldn't get hung up on this one remark code. You already know that this is the patient responsibility and that it's not covered by their insurance, why the insurance is saying it's a specialty claim submitted as general only they can answer that question.

 

[Keating.angie@gmail.com]

Okay, thanks Doreen! That was why I was confused. That part didn't make any sense to me. I wasn't sure if there was a general explanation for that.