Remark code N130

This is the very common eligibility denial that occurs as the patient’s plan has limitations or restrictions on services
that is outlined based on any special conditions that need to be met for full coverage. So, it is important to check the
details before providing services to the patient.

1. The services provided to the patient may not be covered under the patient’s current benefit plan and it was part of the previous calendar year plan that has now been exhausted.
2. Insufficient documentation: If the submitted document does not justify the number of frequency of services billed like incomplete medical records, Progress notes. So, it states that this much frequency was not needed hence denial occurs.
3. Lack of pre-authorization: Some services may require pre-authorization and if provider does not obtain the prior approval before performing the service it can be denied.
4.  Payer guideline: Some payers have specific coverage limitations or guidelines regarding the frequency or number of services that will be reimbursed.

5. System is not updated: If you call the insurance, they state that the mentioned CPT can be reimbursed only twice a year, but it was not updated on time.

Also read: Denial 151