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Wiki understanding remark codes

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lindam@caricures.com

Networker
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Location
Allentown, PA
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I've been getting claim denials with the following remark codes - 16 - claim/service lacks information which is needed for adjudication. Claim submitted like we usually do. On the same claim - N521 MISMATCH BETWEEN SUBMITTED PROV INFO & PROV INFOR STORED IN SYSTEM. And N152 - Missing/incomplete/invalid replacement claim information. Again resubmitted like I usually do. This is a Horizon BCBSNJ plan that we submit to our local Highmark (PA). I wanted to ask on Availity about these messages, but I don't know what "reason for " code to use - if is more a question than anything. Any insight would be appreciated.
 
Usually this error means that whom ever the provider you are submitting the claim for, their information on the claim does not match up with either the NPPES website information, or the information the home plan has. You may have to call the home plan. We have had this a couple times and it was the taxonomy code that wasn't matching up.
 
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