Denial Code Decoder
N179 — Payer asked the member for information
The payer has requested additional information from the PATIENT — accident details, other-coverage questionnaires, student status — and is pending the claim until the member responds. Your claim is hostage to a form sitting on the patient's kitchen table.
Billable to the patient? Not yet — the claim is pending, not denied. It may deny later if the member never responds.
Where this denial is born
- Front desk
- Coding
- Claim build
- Submission
- Adjudication
This denial is usually created at the highlighted stage — that is where prevention lives.
Answer the questions — follow the path
The same questions an experienced biller asks, in order. Your answers draw the route to the right action.
Has the patient received and answered the payer's request?
The full decision tree
Has the patient received and answered the payer's request?
- Yes →
Follow up with the payer. Confirm receipt of the member's response and get a reprocessing timeline; diarize the claim for follow-up.
- No →
Contact the patient now. Tell them exactly what the payer sent and why the claim (and possibly their balance) depends on answering it. Note the payer's response deadline — unanswered requests become denials.
Prevention
Flag claim types that trigger member questionnaires (injuries, possible COB) and warn patients at the visit that the payer may write to them and the letter matters.
Related reading
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