Reason Code 176 | Remark Code N592

Code Description
Reason Code: 176 Prescription is not current.
Remark Code: N592 Adjusted because this is not the initial prescription or exceeds the amount allowed for the initial prescription.

 

Common Reasons for Denial

  • Recertified or revised Certificate of Medical Necessity (CMN) or DME Information Form (DIF) for item was not submitted or not on file with Noridian

Next Step

  • Resubmit claim with CMN/DIF if the CMN/DIF is not on file
  • A telephone reopening may be conducted if CMN or DIF is now on file with Noridian

How to Avoid Future Denials

  • Refer to applicable Local Coverage Determination (LCD) and Policy Article to verify a CMN/DIF is required
  • If an initial CMN/DIF is posted to Common Working File (CWF) under another jurisdiction, include a comment on claim
  • For proper claims processing, attach initial CMN or DIF to claim
    • Supplier must submit initial CMN or DIF for item billed

 

Last Updated Apr 18, 2018