N115 Denial Code
The decision came from a Local Coverage Determination, the regional Medicare policy that says when this service is covered.
A remark code sits beside the adjustment code on the remit and says why the claim was reduced.
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A Remark Code Is Not the Denial
The adjustment code says the claim was reduced. This one says why. You need both to know what to send back.
What to Do
Find the LCD by number and read its covered indications and its diagnosis list. Then check the diagnosis actually on the claim. Most of these are won by adding the supporting diagnosis that was in the chart and never made it onto the claim.
Code meanings verified against x12.org/codes/remittance-advice-remark-codes. The wording, the pairing and the recommended action are ours, not the payer's.
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Your Questions Answered
What does denial code N115 mean?
The decision came from a Local Coverage Determination, the regional Medicare policy that says when this service is covered.
What should I do about N115?
Find the LCD by number and read its covered indications and its diagnosis list. Then check the diagnosis actually on the claim. Most of these are won by adding the supporting diagnosis that was in the chart and never made it onto the claim.
Which denial codes appear with N115?
N115 commonly rides with CO 50, PR 96. The adjustment code says the claim was reduced; the remark code says why.
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