Question Remit code 50

[spkhandekar]

On EOB what is the understanding of Remit code 50 with N130?

 

[trarut]

I use the Washington Publishing site to look up the CARC and RARC codes: http://www.wpc-edi.com/reference/

Assuming '50' is a CO-50 or PR-50, it means "These are non-covered services because this is not deemed a 'medical necessity' by the payer. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."

Remark Code N130 states "Consult plan benefit documents/guidelines for information about restrictions for this service."

It could simply be a medical necessity problem related to the billed diagnosis or the patient has a coverage restriction in their policy for the service that you billed. You need to review the plan document (available online under eligibility for some payers) or call Provider Services and ask them to explain the particular exclusion or restriction.

Hope this helps!
Tracy

 

[spkhandekar]

Thank you very much Tracy,
Yes this will definitely help me.
I was trying to search,
"Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present." But I didn't find.
Can you please guide me how & where can I find this?

 

[trarut]

The 835 transactions aren't really my strong point. Check out the response from CodingKing on this thread from 2015 in the AAPC forums. You may need help from someone internally who has access to the electronic payment file or to your clearinghouse.

Hopefully, someone better versed in the electronic transactions will see this and provide more help with this part of your question.

 

[spkhandekar]

Okay thanks Tracy.

 

[trarut]

No problem. Wish I had more info to help!