Subscriber must update insurance information
The payer's coordination of benefits record is out of date and only the member can update it.
Usual causes
- Old secondary coverage still listed.
- Dependent moved to a new plan.
The fix
Ask the patient to call the payer and confirm their current coverage. Then request reprocessing of the claim.
Appeal or corrected claim?
Not an appeal. The patient updates the record, then the claim is reprocessed.
Deadline to watch
Timely filing limit; ask the payer to note the pending update.
Exact limits are in your payer contract or provider manual. When in doubt, send the correction or appeal this week.
N197 in short
What does N197 mean?
The payer's coordination of benefits record is out of date and only the member can update it. The official X12 text reads: "The subscriber must update insurance information directly with payer."
What usually causes a N197 denial?
Old secondary coverage still listed. Dependent moved to a new plan.
How do I fix N197?
Ask the patient to call the payer and confirm their current coverage. Then request reprocessing of the claim.
Should I appeal N197 or send a corrected claim?
Call or redirect. Not an appeal. The patient updates the record, then the claim is reprocessed.
What deadline applies to N197?
Timely filing limit; ask the payer to note the pending update.