Denial code M111

Remark code M1 indicates a claim denial because an X-ray wasn't taken within 12 months or close to treatment start.

Remark code M2 indicates that the service is not billed separately when the patient is hospitalized.

Remark code M3 indicates that the claim involves equipment similar to what the patient is already using, impacting coverage.

Remark code M4 indicates the final monthly payment for durable medical equipment has been processed.

Remark code M5 indicates rental payments for equipment may persist up to the 15th month or until it's no longer required.

Remark code M6 indicates that providers must supply and maintain equipment for its entire reasonable lifetime as needed for patient care.

Remark code M7 indicates no rental payments are due after purchase, return, or once rental equals the purchase price.

Remark code M8 indicates denial of blood gas test claims if performed by a supplier or while the patient is on oxygen.

Remark code M9 indicates the tenth rental month for equipment, prompting providers to offer patients a purchase option.

Remark code M10 indicates coverage for equipment purchases is restricted to the initial or tenth month of medical need.

Remark code M11 indicates that billing for DME, orthotics, and prosthetics should be directed to the DME carrier for the patient's zip code.

Remark code M12 indicates if diagnostic tests by a physician include purchased services on the claim, impacting reimbursement.

Remark code M13 indicates that for each specialty within a medical group, only one initial visit is reimbursed.

Remark code M14 indicates no separate payment for injections during an office visit or for visits with injections only.

Remark code M15 indicates that billed services/tests are bundled together, as they're part of one procedure, disallowing separate payments.

Remark code M16 indicates a request to check the insurer's website or bulletins for details on specific policies or decisions.

Remark code M17 indicates payment is approved due to provider's lack of knowledge about non-coverage, with future liability for similar services.

Remark code M18 indicates if services are approved for home use, specifying that hospitals and SNFs are not classified as homes.

Remark code M19 indicates a claim denial due to missing oxygen certification or re-certification documentation.

Remark code M20 indicates a claim issue due to missing, incomplete, or invalid HCPCS codes, requiring correction for payment.

Remark code M21 indicates a claim issue due to missing or invalid residence details for home-based services or items.

Remark code M22 indicates a claim issue due to missing, incomplete, or invalid mileage details.

Remark code M23 indicates that a claim has been processed but lacks the required invoice documentation.

Remark code M24 indicates a claim issue due to missing, incomplete, or invalid data on the number of doses per vial.

Remark code M25 indicates that the service level billed lacks necessary documentation for coverage. Appeal within 120 days if justified.

Remark code M26 indicates that the service level billed isn't justified by provided info, and excess patient charges must be refunded within 30 days.

Remark code M27 indicates the provider is liable for charges waived due to services not being necessary or custodial care, with appeal rights.

Remark code M28 indicates a service isn't eligible for Part B payment when Part A is exhausted or unavailable.

Remark code M29 indicates a claim denial due to the absence of the required operative note/report for processing.

Remark code M30 indicates a claim denial due to a missing pathology report, prompting action to resolve the issue.

Remark code M31 indicates a claim denial due to a missing radiology report, prompting action to provide the necessary documentation.

Remark code M32 indicates a conditional payment made while awaiting the primary payer's decision, which may require a refund if further payment is received.

Remark code M36 indicates the 11th rental month payment is pending until confirmation of the patient's purchase option is provided.

Remark code M37 indicates a service isn't covered if the patient is under 35 years old.

Remark code M38 indicates the patient agreed in writing to pay for services not covered by insurance prior to receiving them.

Remark code M39 indicates the patient isn't responsible for payment due to non-compliance with advance notice of non-coverage rules.

Remark code M40 indicates that a claim must be assigned and filed by the practitioner's employer for processing.

Remark code M41 indicates a denial of payment because the patient is not legally required to pay for the service billed.

Remark code M42 indicates that the attending physician must personally sign the medical necessity form for compliance.

Remark code M44 indicates a claim issue due to missing, incomplete, or invalid condition codes, requiring review for correction.

Remark code M45 indicates a claim has been rejected due to missing, incomplete, or invalid occurrence codes.

Remark code M46 indicates a claim issue due to missing, incomplete, or invalid occurrence span codes, requiring correction.

Remark code M47 indicates a claim was rejected due to a missing or invalid Payer Claim Control Number, also known as ICN, CCN, or DCN.

Remark code M49 indicates a claim issue due to missing, incomplete, or invalid value codes or amounts, requiring correction.

Remark code M50 indicates a claim issue due to missing, incomplete, or invalid revenue codes, requiring correction for payment.

Remark code M51 indicates a claim issue due to missing, incomplete, or invalid procedure codes, requiring correction.

Remark code M52 indicates a claim was denied due to missing or incorrect 'from' service dates, requiring correction for processing.

Remark code M53 indicates an error due to missing, incomplete, or invalid days or units of service on a claim.

Remark code M54 indicates an issue with the claim due to missing, incomplete, or invalid total charges.

Remark code M55 indicates a denial for self-administered anti-emetic drugs without a covered oral anti-cancer drug.

Remark code M56 indicates an issue with the payer identifier, such as it being missing, incomplete, or invalid in a claim.

Remark code M59 indicates an error due to missing, incomplete, or invalid 'to' dates of service on a healthcare claim.

Remark code M60 indicates a claim rejection due to a missing Certificate of Medical Necessity form.

Remark code M61 indicates a claim denial because the FDA clinical trial approval period has lapsed, preventing payment.

Remark code M62 indicates a claim issue due to a missing, incomplete, or invalid treatment authorization code.

Remark code M64 indicates a claim issue due to a missing, incomplete, or invalid secondary diagnosis.

Remark code M65 indicates only one interpreting physician charge per claim is allowed for purchased diagnostic tests; separate claims are needed for each physician.

Remark code M66 indicates billing errors for tests with price limits; it advises separating technical and professional components on claims.

Remark code M67 indicates a claim issue due to missing, incomplete, or invalid other procedure codes.

Remark code M69 indicates a claim was paid at the standard rate due to lack of documentation for the modified code.

Remark code M70 indicates the NDC code was converted to a HCPCS code for claim processing, but NDC submission is still required for future claims.

Remark code M71 indicates a reduction in total payment because multiple billed tests overlap.

Remark code M73 indicates a bonus can't be paid on combined services; rebill with separate professional and technical components for eligibility.

Remark code M74 indicates a service is ineligible for Health Professional Shortage Area or Physician Scarcity bonus payments.

Remark code M75 indicates that multiple automated tests done on the same day are bundled together for billing purposes.

Remark code M76 indicates a claim rejection due to missing, incomplete, or invalid diagnosis or condition information.

Remark code M77 indicates a claim issue due to missing or incorrect place of service details, requiring correction for processing.

Remark code M79 indicates a claim issue due to missing, incomplete, or invalid charge information, requiring correction.

Remark code M80 indicates a service isn't covered if performed in the same session/date as a service already processed for the patient.

Remark code M81 indicates that claims must be coded with the most detailed diagnosis information available.

Remark code M82 indicates a service isn't covered by insurance if the patient is under 50 years old.

Remark code M83 indicates a service is not covered unless the patient meets high-risk criteria.

Remark code M84 indicates that billing must use medical codes valid on the service date for claims acceptance.

Remark code M85 indicates a review of physician evaluation and management services for billing accuracy.

Remark code M86 indicates a service was denied as it was already paid for a similar procedure within a specific time period.

Remark code M87 indicates a claim/service is under CFO-CAP prepayment review for compliance before payment.

Remark code M89 indicates a service isn't covered if repeated before age 40, signaling a limit on frequency for patients under this age.

Remark code M90 indicates a service isn't covered if performed more than once within a 12-month period.

Remark code M91 indicates that lab tests under different CLIA certifications require separate billing claims for proper processing.

Remark code M93 indicates a therapy break, starting a new rental period for the delivered equipment, as supported by provided information.

Remark code M94 indicates that provided information fails to justify a therapy break, thus a new capped rental period won't start.

Remark code M95 indicates services are under review or audit due to the Home Health Initiative.

Remark code M96 indicates that only inpatient facilities can bill for technical service components; providers should bill for professional components only.

Remark code M97 indicates a service not paid to a practitioner as it's included in the facility's payment for the patient's place of service.

Remark code M99 indicates a claim issue due to a missing, incomplete, or invalid Universal Product Number/Serial Number.

Remark code M100 indicates a denial for oral anti-emetic drugs not used within 48 hours of chemotherapy.

Remark code M102 indicates a service was denied because it wasn't performed on FDA-approved equipment for the intended use.

Remark code M103 indicates a therapy break is supported by info provided, but the medical need for the billed item isn't, leading to reduced payment.

Remark code M104 indicates a break in therapy is confirmed, starting a new rental period for equipment and noting the fee schedule's maximum approval.

Remark code M105 indicates a break in therapy is unsupported by provided info, resulting in reduced payment approval and no new rental period start.

Remark code M107 indicates a payment reduction due to an ESRD patient's 90-day average hematocrit level exceeding 36.5%.

Remark code M113 indicates a patient started using DMEPOS before the current Competitive Bidding Program contract period.

Remark code M114 indicates a service was aligned with DMEPOS Competitive Bidding rules. Contact your contractor for project details.

Remark code M115 indicates denial of an item when supplied to a patient by a non-contract or non-demo provider.

Remark code M116 indicates a claim was processed under a demo project or program that's ending, affecting future service payments.

Remark code M117 indicates a service is not covered unless the claim is submitted electronically to the insurer.

Remark code M119 indicates a claim issue due to a missing, incomplete, invalid, or inactive National Drug Code.

Remark code M121 indicates payment for a service is approved only if performed alongside a covered cryosurgical ablation.

Remark code M122 indicates a claim rejection due to missing, incomplete, or invalid subluxation level documentation.

Remark code M123 indicates a claim issue due to missing or incorrect drug name, strength, or dosage details.

Remark code M124 indicates a missing declaration on whether the patient owns the equipment needing the part or supply.

Remark code M125 indicates a claim was denied due to missing or invalid details about the service duration needed.

Remark code M126 indicates missing, incomplete, or invalid lab codes within a bundled lab test claim.

Remark code M127 indicates a claim denial due to the absence of the patient's medical record for the billed service.

Remark code M129 indicates an error due to missing or invalid x-ray availability indicators for review in claims.

Remark code M130 indicates a claim denial due to missing invoice or certification of lens cost and type for intraocular lens procedures.

Remark code M131 indicates a claim denial due to the absence of the required physician financial relationship form.

Remark code M132 indicates a claim denial due to a missing pacemaker registration form required for processing.

Remark code M133 indicates a claim was rejected for not specifying the provider or cost of a purchased diagnostic test.

Remark code M134 indicates a service was provided by a facility with financial ties to the referring provider.

Remark code M135 indicates a claim issue due to a missing, incomplete, or invalid plan of treatment.

Remark code M136 indicates a claim error due to missing or invalid proof of physician supervision or evaluation of the service.

Remark code M137 indicates a Part B coinsurance adjustment under a demo project or pilot program for healthcare providers.

Remark code M138 indicates services were rendered to a non-enrolled patient in a demo, limiting coverage to actual participants.

Remark code M139 indicates a denial because services surpassed the coverage limit for the specific demonstration project.

Remark code M141 indicates a claim was denied due to a missing physician-certified plan of care.

Remark code M142 indicates a claim was denied due to a missing American Diabetes Association Certificate of Recognition.

Remark code M143 indicates that the provider needs to update their license information with the insurance payer for claims processing.

Remark code M144 indicates that payment for pre/post-operative care is bundled into the surgery/procedure fee and not paid separately.

Remark code MA01 indicates a right to appeal if you disagree with the payment decision; submit your appeal within 120 days of notice receipt.

Remark code MA02 indicates a right to appeal a determination. Providers must submit a written appeal within 180 days of notice receipt.

Remark code MA04 indicates a secondary claim requires primary payer details, which were missing or unreadable, to process payment.

Remark code MA07 indicates that the claim details have been sent to Medicaid for additional review.

Remark code MA08 indicates supplemental coverage is not Medigap or you're not in Medicare; claim info wasn't forwarded.

Remark code MA09 indicates a claim was filed as unassigned but treated as assigned per the existing agreement.

Remark code MA10 indicates a patient overpayment that requires the healthcare provider to issue a refund to the patient.

Remark code MA12 indicates a billing issue where legal entitlement to charge for services by the provider in question has not been proven.

Remark code MA13 alerts healthcare providers that billing patients for unreported amounts with PR group code may incur penalties.

Remark code MA14 indicates a one-time payment for services outside a patient's prepaid health plan, with future non-plan services not covered.

Remark code MA15 indicates your claim was split to speed up processing; expect a notice for the remaining services soon.

Remark code MA16 indicates the patient has Black Lung coverage; claims should be directed to the Dept. of Labor, Federal Black Lung Program.

Remark code MA17 indicates that the primary insurer has paid and providers must seek refunds from any secondary insurer that overpaid.

Remark code MA18 indicates that claim details have been sent to the patient's supplemental insurer for further processing.

Remark code MA19 indicates that a claim wasn't sent to Medigap due to incorrect insurer information; providers should verify and resubmit directly.

Remark code MA20 indicates a denial for SNF coverage when care mainly involves urethral catheter use for convenience or incontinence control.

Remark code MA21 alerts providers of a name and sex mismatch in SSA records, requiring verification for accurate billing.

Remark code MA22 indicates a payment under $1.00 was not issued, as it's below the minimum threshold for processing.

Remark code MA23 indicates a demand bill has been approved following a medical review process.

Remark code MA24 indicates a billing overlap for Christian Science Sanitarium/SNF services within the same benefit period.

Remark code MA25 indicates if a patient has switched hospice providers, they cannot change again within the same benefit period.

Remark code MA26 alerts healthcare providers that a billing rule was previously communicated to them.

Remark code MA27 indicates a claim issue due to a missing, incomplete, or invalid entitlement number or name.

Remark code MA28 indicates a notice for non-assignment accepting physicians/suppliers, serving informational purposes only without granting extra appeal rights.

Remark code MA30 indicates a claim was denied due to a missing, incomplete, or invalid type of bill on the submission.

Remark code MA31 indicates an issue with the billing period dates, which are either missing, incomplete, or invalid on a claim.

Remark code MA32 indicates a claim issue due to missing or invalid covered days within the billing period.

Remark code MA33 indicates a claim issue due to missing, incomplete, or invalid non-covered days in the billing period.

Remark code MA34 indicates an error due to missing or incorrect coinsurance days in the billing period for a claim.

Remark code MA35 indicates an issue with the number of lifetime reserve days reported; they are missing, incomplete, or invalid.

Remark code MA36 indicates a claim issue due to a missing, incomplete, or invalid patient name, requiring correction for processing.

Remark code MA37 indicates a claim issue due to a missing, incomplete, or invalid patient address, requiring correction for processing.

Remark code MA39 indicates a claim denial due to missing, incomplete, or invalid gender information on the submitted form.

Remark code MA40 indicates a claim denial due to a missing, incomplete, or invalid admission date on the submitted documentation.

Remark code MA41 indicates a claim issue due to missing, incomplete, or invalid admission type information.

Remark code MA42 indicates a claim issue due to missing, incomplete, or invalid admission source information.

Remark code MA43 indicates a claim issue due to missing, incomplete, or invalid patient status information.

Remark code MA44 indicates a final decision with no appeal rights, as the adjudication is based on legal grounds.

Remark code MA45 indicates that, as notified before, part or all of your payment is reserved in a special account.

Remark code MA46 indicates that despite reviewing new information, no extra payment will be made.

Remark code MA47 indicates a provider opted out of Medicare, agreeing not to bill for services. Thus, Medicare won't pay this claim; the patient must cover costs.

Remark code MA48 indicates an issue with the name or address details of the responsible party or primary payer in billing documents.

Remark code MA50 indicates a claim issue due to a missing or invalid Investigational Device Exemption or Clinical Trial number.

Remark code MA53 indicates an issue with the Competitive Bidding Demonstration Project ID; it's missing, incomplete, or invalid.

Remark code MA54 indicates a delay in receiving the required physician certification or election consent for hospice care.

Remark code MA55 indicates a service isn't covered because the patient chose medical care, nullifying their election for religious non-medical health services.

Remark code MA56 indicates a provider opted out of Medicare and can't bill Medicare. The patient must pay, but charges are limited by law.

Remark code MA57 indicates a patient has revoked their request for non-medical health care due to religious reasons.

Remark code MA58 indicates a claim issue due to missing or invalid release of information indicator.

Remark code MA59 indicates a patient overpayment. Providers must refund the excess within 30 days as per the patient responsibility amount.

Remark code MA60 indicates an issue with the patient's relationship to the insured; it's missing, incomplete, or invalid.

Remark code MA61 indicates a claim issue due to a missing, incomplete, or invalid social security number.

Remark code MA62 indicates a telephone review decision affecting claim payment or denial for healthcare providers.

Remark code MA63 indicates a claim denial due to a missing, incomplete, or invalid principal diagnosis.

Remark code MA64 indicates a claim's processing is on hold until primary and secondary payer details are provided to determine third payer responsibility.

Remark code MA65 indicates a claim issue due to a missing, incomplete, or invalid admitting diagnosis, requiring correction.

Remark code MA66 indicates a claim rejection due to a missing or incorrect principal procedure code.

Remark code MA67 indicates an adjustment made to correct a previous claim submission in the healthcare billing process.

Remark code MA68 indicates a claim wasn't crossed over due to incomplete secondary insurance info; providers must ensure data accuracy for proper routing.

Remark code MA69 indicates a claim issue due to missing, incomplete, or invalid remarks that require correction for processing.

Remark code MA70 indicates a claim issue due to a missing, incomplete, or invalid provider representative signature.

Remark code MA71 indicates a claim issue due to a missing or invalid provider signature date, requiring correction for processing.

Remark code MA72 indicates a patient overpayment for services; a refund must be issued within 30 days for the excess amount paid.

Remark code MA73 indicates a Medicare demo remittance; no fee-for-service payment due to the patient's managed care election.

Remark code MA74 indicates a replacement payment for a claim due to the original being lost, damaged, or returned.

Remark code MA75 indicates a claim issue due to a missing or invalid patient or representative signature.

Remark code MA76 indicates a claim issue due to an absent or incorrect provider ID for home health or hospice in care plan oversight.

Remark code MA77 indicates a patient overpayment. Providers must refund the excess within 30 days, as detailed in the payment notice.

Remark code MA79 indicates a billing error where charges exceed the set interim rate for services provided.

Remark code MA80 indicates no separate payment for a claim as it's covered under a hospital's demonstration project payment.

Remark code MA81 indicates a claim issue due to a missing, incomplete, or invalid provider signature.

Remark code MA83 is a notice that claims processing is pending due to missing primary or secondary payer details.

Remark code MA84 indicates a discrepancy with patient participation in the National Emphysema Treatment Trial; verification required with Johns Hopkins University.

Remark code MA88 indicates a claim issue due to missing or incorrect insured's address/phone for the primary payer.

Remark code MA89 indicates an issue with the patient's relationship to the insured for the primary payer, requiring correction.

Remark code MA90 indicates an issue with the primary insured's employment status code, such as it being missing, incomplete, or invalid.

Remark code MA91 indicates the decision made on an appeal you filed regarding a healthcare claim.

Remark code MA92 indicates a claim was denied due to missing plan details for secondary or tertiary insurance coverage.

Remark code MA93 indicates a non-PIP claim, meaning it's not subject to Periodic Interim Payment adjustments.

Remark code MA94 indicates a claim was denied because it lacked a statement certifying the attending physician is not a hospice employee.

Remark code MA96 indicates a claim was denied because it was filed for Medicare Managed Care without valid patient enrollment.

Remark code MA97 indicates a claim issue due to a missing or invalid Medicare contract or clinical trial number.

Remark code MA99 indicates that a claim has been denied due to missing, incomplete, or invalid Medigap information.

Remark code MA100 indicates a claim issue due to missing or invalid date of current illness or symptoms.

Remark code MA103 indicates an additional payment adjustment for hemophilia treatment services.

Remark code MA106 indicates a PIP claim, alerting providers of payment adjustments under the Periodic Interim Payment system.

Remark code MA107 indicates a paper claim was rejected due to over three data items in field 19, requiring correction.

Remark code MA108 indicates a paper claim was rejected due to multiple data items in field 23, requiring correction for processing.

Remark code MA109 indicates a claim was settled following ambulatory surgical payment rules.

Remark code MA110 indicates a claim was denied due to missing or invalid details on whether diagnostic tests were done externally or included.

Remark code MA111 indicates a claim issue due to missing or invalid test purchase price, or lab details.

Remark code MA112 indicates a claim issue due to missing or invalid group practice information, requiring correction for processing.

Remark code MA113 indicates a claim rejection due to an invalid or incomplete TIN. Correct your TIN to resubmit and process claims; patient billing is on hold.

Remark code MA114 indicates a claim was denied due to missing or incorrect details about the service location.

Remark code MA115 indicates an error due to missing or invalid location details for services in a Health Professional Shortage Area.

Remark code MA116 indicates a claim issue where the 'Homebound' status is missing, affecting lab service location validation.

Remark code MA117 indicates a $1.00 user fee has been applied to the claim by the payer for processing.

Remark code MA118 indicates that Medicare has not issued payment for services provided to a veteran at a VA facility, with applicable coinsurance or deductible.

Remark code MA120 indicates a claim was denied due to a missing, incomplete, or invalid CLIA certification number.

Remark code MA121 indicates an issue with a claim due to a missing, incomplete, or invalid x-ray date, requiring correction.

Remark code MA122 indicates a claim issue due to a missing or incorrect initial treatment date.

Remark code MA123 indicates your center wasn't chosen for a study, thus payment for services is not approved.

Remark code MA125 indicates that, by law, the payment received is considered full settlement with no additional billing allowed.

Remark code MA126 indicates coverage for a pancreas transplant is only provided if a kidney transplant is also performed.

Remark code MA128 indicates a claim denial due to a missing or invalid FDA approval number on medical documentation.

Remark code MA130 indicates a claim was rejected due to incomplete/invalid info and must be resubmitted with correct details for processing.

Remark code MA131 indicates a physician has been paid for services tied to a demo claim; the claim must be withdrawn and payment refunded for processing.

Remark code MA132 indicates an adjustment made to align charges with the pre-demonstration rate for specific services.

Remark code MA133 indicates a claim conflict with an inpatient stay; services billed should exclude those provided during that stay.

Remark code MA134 indicates a claim issue due to a missing or invalid provider number for the patient's residence facility.

Remark code N1 is a notice that you can appeal the payment decision within set time limits by following the instructions provided.

Remark code N2 indicates an allowance adjustment based on the plan's most appropriate treatment provision.

Remark code N3 indicates a claim denial due to a missing consent form, alerting providers to submit necessary documentation.

Remark code N4 indicates an EOB from prior insurance is missing, incomplete, or invalid, requiring action for claim processing.

Remark code N5 indicates that an EOB was received from a prior payer, but the claim is not found in the current payer's records.

Remark code N6 indicates that payment for covered care is limited to what Medicare Part A/B would allow under FEHB law (U.S.C. 8904(b)).

Remark code N7 indicates that the claim has been processed with consideration under Major Medical provisions.

Remark code N8 indicates a crossover claim was denied by a previous payer due to incomplete data. Resubmit the claim with full details for proper adjudication.

Remark code N9 indicates an adjustment based on the estimated payment from a prior insurer.

Remark code N10 indicates an adjustment due to a review organization's findings or professional consultation during claims processing.

Remark code N11 indicates a denial has been overturned following a medical review, ensuring accurate claim processing.

Remark code N12 indicates coverage is supplemental to Medicare, and as the member isn't enrolled in Medicare, they must pay the portion Medicare would have covered.

Remark code N13 indicates a payment adjustment based on the use of professional/technical component modifiers in billing.

Remark code N15 indicates that billing for newborn services should be done independently from other charges.

Remark code N16 indicates the patient's out-of-pocket maximum is met, leading to a higher payment percentage for covered services.

Remark code N19 indicates that the billed service is considered incidental to the primary procedure performed.

Remark code N20 indicates a service isn't payable when billed with another service on the same date.

Remark code N21 indicates that an item on a claim has been split into multiple lines for faster processing.

Remark code N22 indicates a procedure code update to better reflect services provided, aiding accurate billing and reimbursement.

Remark code N23 indicates potential changes in patient liability due to benefits coordination with other insurers or benefit caps.

Remark code N24 indicates a claim issue due to missing or invalid EFT banking details, requiring action for payment processing.

Remark code N25 indicates a third-party administrator handles claims but doesn't bear financial responsibility for your benefit plan.

Remark code N26 indicates a claim was denied due to a missing itemized bill or statement, requiring submission for processing.

Remark code N27 indicates an issue with the claim due to a missing, incomplete, or invalid treatment number.

Remark code N28 indicates that a claim was denied because required consent form documentation was not properly completed or provided.

Remark code N30 indicates that the patient's insurance plan does not cover the service provided.

Remark code N31 indicates an issue with a claim due to a missing or invalid prescribing provider identifier.

Remark code N32 indicates that a claim should be filed by the healthcare provider who actually performed the service.

Remark code N33 indicates a claim denial due to no recorded health check before treatment began. Address to ensure coverage.

Remark code N34 indicates a claim was rejected due to an improper form or format used for the submitted service.

Remark code N35 indicates a decision made after a program integrity or utilization review affecting payment.

Remark code N36 indicates that a claim must comply with the primary insurer's rules before secondary payment consideration.

Remark code N37 indicates a claim issue due to a missing, incomplete, or invalid tooth number or letter on dental claims.

Remark code N39 indicates an issue with billing where the dental procedure code does not match the specified tooth number/letter.

Remark code N40 indicates a claim denial due to missing radiology films or images required for processing.

Remark code N42 indicates a claim denial due to a missing mental health assessment in the documentation.

Remark code N43 indicates that the patient's allotted bed hold or leave days have been surpassed in a healthcare facility.

Remark code N45 indicates a payment adjustment based on the authorized amount for a healthcare service or procedure.

Remark code N46 indicates an error due to missing, incomplete, or invalid admission hour on a healthcare claim.

Remark code N47 indicates a claim denial due to a conflict with another inpatient stay, requiring review.

Remark code N48 indicates a discrepancy between claim details and data from another insurer, requiring review.

Remark code N49 indicates that the payer requires validation of court-ordered coverage information for claim processing.

Remark code N50 indicates a claim denial due to missing, incomplete, or invalid discharge information.

Remark code N51 indicates an electronic interchange agreement is missing for the provider/submitter in billing records.

Remark code N52 indicates a claim denial because the patient wasn't in the provider's managed care plan on the service date.

Remark code N53 indicates an issue with the claim due to a missing or invalid pick-up address detail.

Remark code N54 indicates a discrepancy between claim details and pre-certified or authorized services.

Remark code N55 indicates that billing procedures for group/referring/performing providers were incorrect.

Remark code N56 indicates an error where the procedure code used does not match the service provided or the date of service.

Remark code N57 indicates a claim denial due to a missing, incomplete, or invalid prescribing date.

Remark code N58 indicates an issue with the patient liability amount, such as missing, incomplete, or invalid data in a claim.

Remark code N59 alerts healthcare providers to consult their manual for specific program and provider details.

Remark code N61 indicates that services should be rebilled on separate claims for proper processing.

Remark code N62 indicates a claim spans multiple rate periods, requiring resubmission as separate claims for accurate processing.

Remark code N63 indicates that services should be rebilled on separate claim lines for proper processing.

Remark code N64 indicates that a claim's 'from' and 'to' dates of service must not be the same for processing.

Remark code N65 indicates a claim issue where the procedure code/rate count is undetermined or not on file for the service date/provider.

Remark code N67 indicates professional services aren't paid separately as they're included in a facility's payment under a demo project.

Remark code N68 indicates a prior payment is reversed due to patient coverage by a demo project; contact the facility for payment.

Remark code N69 indicates a PPS code was altered during claims processing, potentially affecting reimbursement.

Remark code N70 indicates that services are bundled for billing and payment under a single comprehensive charge.

Remark code N71 indicates a processed unassigned claim for specific services was treated as assigned, as mandated by law. Providers must comply.

Remark code N72 indicates a PPS code revision by medical reviewers due to lack of clinical record support.

Remark code N74 indicates a need to resubmit separate claims for services given in distinct calendar months.

Remark code N75 indicates a claim denial due to missing or invalid tooth surface information for dental billing.

Remark code N76 indicates an issue with the claim due to missing, incomplete, or invalid number of riders.

Remark code N77 indicates a claim issue due to a missing, incomplete, or invalid designated provider number.

Remark code N78 indicates that a claim was denied because the EPSDT checkup for a child or teen lacks required components.

Remark code N79 indicates a billing error where the service provided doesn't match the patient's location details.

Remark code N80 indicates a claim issue due to missing, incomplete, or invalid prenatal screening information.

Remark code N81 indicates an incompatibility between the billed procedure and the tooth surface code on a dental claim.

Remark code N82 indicates that providers must accept insurance payment as full settlement if their contract with a third party payer requires it.

Remark code N83 indicates a non-appealable decision made under a specific demonstration project's rules.

Remark code N84 indicates that additional installment payments are expected to be made for a claim.

Remark code N85 indicates the payment received is the final installment for a billed service.

Remark code N86 indicates coverage for biofeedback training for urinary incontinence requires a failed trial of pelvic muscle exercises.

Remark code N87 indicates that biofeedback therapy for home use is not covered by the patient's insurance plan.

Remark code N88 indicates conditional payment made for services included in a Home Health Agency's (HHA) consolidated billing.

Remark code N89 indicates a claim's payment info was sent to multiple payers, but only one secondary payer can be listed on this remittance.

Remark code N90 indicates a service is reimbursable only if performed by the attending physician.

Remark code N91 indicates that the services in question were not considered during the appeal review process.

Remark code N92 indicates that the claim was denied because the facility lacks certification for digital mammography services.

Remark code N93 indicates that services at different locations require separate claims and cannot be combined on a single claim.

Remark code N94 indicates a claim/service was denied as a more specific taxonomy code is needed for proper adjudication.

Remark code N95 indicates that the provider's type or specialty is not authorized to bill for the specified service.

Remark code N96 indicates that coverage requires documentation of failed conventional therapy and suitability for surgery with anesthesia.

Remark code N97 indicates exclusions for coverage, such as stress incontinence or urinary issues related to certain neurologic diseases.

Remark code N98 indicates a required successful test stimulation for implant coverage, based on a 50%+ improvement in voiding diaries.

Remark code N99 indicates a requirement for patients to maintain a voiding diary to assess the outcome of an implant procedure effectively.

Remark code N103 indicates a patient was in custody when services were rendered, and the payer does not cover these costs unless the individual is liable by law.

Remark code N104 indicates a claim isn't payable in the jurisdiction area. Find the right Medicare contractor via the CMS website.

Remark code N105 indicates a claim was sent incorrectly for an RRB beneficiary and should be submitted to Palmetto GBA via the provided address or call for EDI details.

Remark code N106 indicates payment for SNF inpatient services is made to the SNF only, and providers should bill the SNF, not the patient.

Remark code N107 indicates that services to SNF inpatients must be included on the inpatient claim, not billed as outpatient services.

Remark code N108 indicates a claim issue due to missing, incomplete, or invalid upgrade information, requiring action for resolution.

Remark code N109 indicates a claim/service was selected for detailed verification during a complex review process.

Remark code N110 indicates a claim denial because the facility lacks certification for film mammography services.

Remark code N111 indicates no appeal rights, except for duplicate claims/services, as the service was previously billed and adjudicated.

Remark code N112 indicates a claim is not part of your electronic remittance advice, requiring alternative processing.

Remark code N113 indicates coverage is limited to one initial visit per physician, group practice, or provider.

Remark code N114 indicates payment is based on the lesser of a blended rate or submitted charge for ambulance services during fee schedule transition.

Remark code N115 indicates a claim decision based on Local Coverage Determination (LCD), guiding item/service coverage.

Remark code N116 indicates conditional payment for services in a patient's home, subject to recoupment if under concurrent HHA care.

Remark code N117 indicates a service is reimbursable only once per patient's lifetime, impacting claim payments.

Remark code N118 indicates a service isn't covered if billed more than once every 28 days, alerting providers to billing frequency limits.

Remark code N119 indicates a service isn't covered if billed within 28 days of a patient's 5+ day stay in an inpatient or SNF.

Remark code N120 indicates a payment adjustment under the home health prospective payment system due to patient transfer or readmission.

Remark code N121 indicates Medicare Part B won't cover services by certain practitioners during a Medicare Part A SNF stay.

Remark code N122 indicates an add-on procedure code was billed without the primary service, which is required for valid billing.

Remark code N123 indicates a split service, signifying only part of the units from the original submission are billed.

Remark code N124 indicates a denial of payment for a service/item deemed not necessary based on provided information, with patient liability established by prior written consent.

Remark code N125 indicates a denial or reduced payment for a service/item due to insufficient information to justify the necessity. Refunds to patients are required within 30 days.

Remark code N126 indicates coverage denial for services to individuals deported, as per Social Security Records and payer policy.

Remark code N127 indicates a claim was incorrectly sent for a UMWA beneficiary and should be resubmitted to the correct payer.

Remark code N128 indicates the amount is from the pre-coverage allowance, not payable by the insurer.

Remark code N129 indicates a claim denial because the patient's age does not meet the eligibility requirements for coverage.

Remark code N130 indicates a need to review plan documents or guidelines for service restrictions.

Remark code N131 indicates that payments from various contracts cannot surpass the allowed amount for the provided service.

Remark code N132 indicates that payments will stop after a 30-day grace period for services by a debarred or excluded provider.

Remark code N133 indicates separate processing for services needing predetermination and those requesting payment.

Remark code N134 alerts providers that payment is scheduled for a service. If treatment stopped, contact Customer Service for guidance.

Remark code N135 indicates that record fees fall under patient responsibility, up to the co-payment amount set by their insurance plan.

Remark code N136 indicates the need to contact Arizona's Consumer Assistance Office for appeal process information.

Remark code N137 indicates providers can appeal to the payer or file a complaint for urgent care coverage decisions without an initial appeal.

Remark code N138 indicates a dental advisor's opinion can be contested by submitting additional information and radiographs for a second review.

Remark code N139 indicates a non-participating provider cannot appeal unless appointed by the beneficiary in writing.

Remark code N140 alerts providers they're not authorized OCONUS providers and outlines appeal steps if appointed by a beneficiary.

Remark code N141 indicates that the claim was denied because the patient wasn't in long-term care for some or all service dates.

Remark code N142 indicates that the initial claim was denied. Providers should resubmit as a new claim, not as a correction or replacement.

Remark code N143 indicates that the claim was denied because the patient wasn't enrolled in hospice care for some or all service dates.

Remark code N144 indicates a change in billing rates within the service dates, affecting claim reimbursement.

Remark code N146 indicates a claim denial due to the absence of required screening documentation.

Remark code N147 indicates a long-term care payment issue due to a missing or incorrect patient ID on the assignment request.

Remark code N148 indicates a claim issue due to a missing or incorrect date of the last menstrual period.

Remark code N149 indicates that providers should consolidate and resubmit all relevant services together on one claim form.

Remark code N150 indicates a claim denial due to a missing, incomplete, or invalid model number on the submitted documentation.

Remark code N151 indicates payment for telephone services is pending until face-to-face contact requirements are fulfilled.

Remark code N152 indicates a claim was denied due to missing, incomplete, or invalid information for a replacement claim.

Remark code N153 indicates an issue with the claim due to missing, incomplete, or invalid room and board rate details.

Remark code N154 indicates a delay in payment due to the need for correcting the provider's mailing address.

Remark code N155 alerts providers that records lack other insurance info, prompting submission for accurate billing.

Remark code N156 indicates the patient owes the balance between the insurance-approved amount and the elective treatment cost.

Remark code N157 indicates that transportation to or from the specified destination is not covered by the insurance plan.

Remark code N158 indicates that transportation by non-ambulance vehicles is not covered by the insurance plan.

Remark code N159 indicates payment denial or reduction due to non-covered mileage when the patient isn't in the ambulance.

Remark code N160 indicates that a patient's selection is required before payment for a specific healthcare service or supply can be processed.

Remark code N161 indicates coverage for a drug/service/supply is provided only if the related service is also covered.

Remark code N162 indicates a paid claim for a test not covered under current lab certification, warning of future denials if not corrected.

Remark code N163 indicates that the medical record lacks documentation to justify the billing code used, as per code definitions.

Remark code N167 indicates that the billed charges surpass the limit allowed for post-transplant care coverage.

Remark code N170 indicates that a current certificate of medical necessity must be updated or replaced for billing.

Remark code N171 indicates that payment for repair or replacement is not covered or exceeds the item's original cost.

Remark code N172 indicates that the patient is not responsible for payment of denied or adjusted charges for updated services or items.

Remark code N173 indicates that claim processing is incomplete due to missing hospital stay dates for the care episode.

Remark code N174 indicates a service or item isn't covered, but patient financial responsibility is capped at the adjustment amount listed under 'PR'.

Remark code N175 indicates a claim denial due to the absence of necessary approval from the review organization.

Remark code N176 indicates coverage for services on a US-registered ship is limited to when it's in US waters and provided by a US-licensed doctor.

Remark code N177 indicates a claim wasn't sent to the secondary insurer as no further payment is expected from them.

Remark code N178 indicates a claim denial due to missing pre-operative images or visual field results required for processing.

Remark code N179 indicates that further details are needed from the patient for claim reconsideration.

Remark code N180 indicates an item or service doesn't meet the billing category criteria. Ensure correct coding to avoid claim denials.

Remark code N181 indicates that further details are needed from a different provider who participated in the service for billing.

Remark code N182 indicates that the claim/service must adhere to the specific billing schedule of the patient's insurance plan.

Remark code N183 indicates a predetermination advisory, signaling that extra documentation will be needed to process benefits when the service is billed.

Remark code N184 indicates that providers must rebill technical and professional components of a service as separate claims.

Remark code N185 indicates that the claim/service should not be resubmitted as it has been processed and further action is not required.

Remark code N186 indicates a Non-Availability Statement (NAS) is needed for the service and advises contacting a Military Treatment Facility.

Remark code N187 indicates a review request can be made within the specified time after notice receipt per contract or plan documents.

Remark code N188 indicates the procedure code submitted doesn't align with the approved care level.

Remark code N189 indicates a one-time exception payment for a service not typically covered under the plan's benefits.

Remark code N190 indicates a claim was rejected due to a missing contract indicator, which is essential for processing.

Remark code N191 indicates that the provider needs to update insurance details directly with the insurance payer for claims processing.

Remark code N192 indicates that the patient has Medicaid or is a Qualified Medicare Beneficiary, impacting billing.

Remark code N193 indicates a service may be covered by a specific federal, state, or local program, suggesting an alternate payer.

Remark code N194 indicates denial of payment for technical components when the provider doesn't own the equipment utilized.

Remark code N195 indicates that the technical part of a service must be billed independently from the professional component.

Remark code N196 indicates that the patient may have other insurance coverage that should be considered primary.

Remark code N197 indicates that the subscriber needs to provide updated insurance details directly to the insurance payer.

Remark code N198 indicates that the billing provider must be associated with the listed pay-to provider for claim payment.

Remark code N199 indicates a payer has approved extra payment or recoupment following their review or audit.

Remark code N200 indicates that the professional part of a service must be billed separately for accurate payment.

Remark code N202 indicates that further details or explanations will be provided in a separate communication.

Remark code N203 indicates an error due to missing, incomplete, or invalid anesthesia time or units on a claim.

Remark code N204 indicates a service is being reviewed for a pre-existing condition; providers must submit the past year's medical records.

Remark code N205 indicates that the information submitted was not readable and needs clarification for processing.

Remark code N206 indicates that the documentation provided doesn't align with the claim details, potentially affecting reimbursement.

Remark code N207 indicates an error due to missing, incomplete, or invalid weight information in a claim submission.

Remark code N208 indicates an issue with the claim due to a missing, incomplete, or invalid Diagnosis-Related Group (DRG) code.

Remark code N209 indicates a claim issue due to a missing, incomplete, or invalid taxpayer identification number.

Remark code N210 indicates a decision that can be appealed by healthcare providers for claim resolution.

Remark code N211 indicates that the decision is final and cannot be appealed by the healthcare provider.

Remark code N212 indicates charges were processed under a Point of Service benefit plan.

Remark code N213 indicates a claim issue due to missing or invalid DRG status info for a specific facility or unit.

Remark code N214 indicates a claim denial due to missing or invalid history of initial surgical procedures.

Remark code N215 indicates that secondary payers won't need a primary payer's claim decision to process their own claim for a service.

Remark code N216 indicates a service isn't covered or the patient isn't enrolled in the relevant benefit package.

Remark code N217 indicates that reimbursement is limited to one service location per provider for each claim submitted.

Remark code N218 indicates that the provider must supply and service an item as long as needed, with maintenance costs covered as per the contract.

Remark code N219 indicates a payment adjustment based on the allowed amount from a previous insurance payer.

Remark code N220 indicates a need to visit the payer's website or contact their Customer Service for forms and instructions to file a provider dispute.

Remark code N221 indicates a claim denial due to a missing Admitting History and Physical report.

Remark code N222 indicates an incomplete or invalid Admitting History and Physical report in healthcare claims.

Remark code N223 indicates a claim denial due to missing evidence of patient benefit in the initial treatment period.

Remark code N224 indicates a claim denial due to incomplete or invalid documentation of patient benefit during initial treatment.

Remark code N226 indicates an issue with the ADA Certificate of Recognition, requiring validation or completion for processing.

Remark code N227 indicates an incomplete or invalid Certificate of Medical Necessity on a healthcare claim.

Remark code N228 indicates a claim denial due to an incomplete or invalid consent form submission in the billing process.

Remark code N229 indicates an issue with a claim due to an incomplete or invalid contract indicator in healthcare billing.

Remark code N230 alerts providers that a claim lacks valid confirmation of patient-owned equipment needing parts or supplies.

Remark code N231 indicates an invalid or incomplete invoice/statement for the cost of a lens or the type of intraocular lens used.

Remark code N232 indicates an incomplete or invalid itemized bill/statement, requiring correction for claim processing.

Remark code N233 indicates an incomplete or invalid operative note/report, requiring action for proper claim processing.

Remark code N234 indicates an incomplete or invalid oxygen certification or re-certification in a claim submission.

Remark code N235 indicates a claim issue due to an incomplete or invalid pacemaker registration form.

Remark code N236 indicates an incomplete or invalid pathology report, requiring review or additional information for claims processing.

Remark code N237 indicates an incomplete or invalid patient medical record for a specific service, requiring action for proper billing.

Remark code N238 indicates a claim was denied due to an incomplete or invalid physician-certified plan of care.

Remark code N239 indicates an issue with a claim due to an incomplete or invalid physician financial relationship form.

Remark code N240 indicates a claim denial due to an incomplete or invalid radiology report.

Remark code N241 indicates a claim denial due to incomplete or invalid review organization approval.

Remark code N242 indicates a claim denial due to incomplete or invalid radiology films or images submitted.

Remark code N243 indicates a claim denial due to an incomplete, invalid, or unapproved screening document.

Remark code N244 indicates a claim denial due to incomplete or invalid pre-operative images or visual field results.

Remark code N245 indicates a claim was denied due to incomplete or invalid plan information for other insurance.

Remark code N246 indicates that state-regulated payment limits apply to the billed healthcare service.

Remark code N247 indicates an issue with the assistant surgeon's taxonomy, such as missing or incorrect information.

Remark code N248 indicates a claim issue due to a missing or invalid assistant surgeon's name, requiring correction for processing.

Remark code N249 indicates an issue with the assistant surgeon's primary identifier, such as missing or invalid details.

Remark code N250 indicates an issue with the assistant surgeon's secondary identifier, such as missing or invalid details.

Remark code N251 indicates an issue with the claim: the attending provider's taxonomy code is missing, incomplete, or invalid.

Remark code N252 indicates an issue with a claim due to a missing or invalid attending provider's name, requiring correction.

Remark code N253 indicates a claim issue due to a missing or invalid attending provider's primary identifier.

Remark code N254 indicates an issue with a missing or incorrect secondary identifier for the attending provider in a claim.

Remark code N255 indicates an issue with the claim due to missing or invalid billing provider taxonomy information.

Remark code N256 indicates an issue with the claim due to a missing or invalid billing provider/supplier name.

Remark code N257 indicates an issue with the billing provider's primary identifier, such as missing or incorrect details.

Remark code N258 indicates an error due to a missing, incomplete, or invalid address for the billing provider or supplier.

Remark code N259 indicates an issue with a secondary identifier for the billing provider/supplier, requiring correction.

Remark code N260 indicates a claim was denied due to missing or incorrect billing provider contact information.

Remark code N261 indicates an issue with a claim due to a missing or invalid operating provider name.

Remark code N262 indicates an issue with the operating provider's primary identifier, such as it being missing or incorrect.

Remark code N263 indicates an issue with a missing or incorrect secondary identifier for the operating provider.

Remark code N264 indicates a claim issue due to a missing or invalid ordering provider name, requiring correction for payment.

Remark code N265 indicates an issue with a claim due to a missing or invalid ordering provider's identifier.

Remark code N266 indicates an issue with a claim: the ordering provider's address is missing, incomplete, or invalid.

Remark code N267 indicates an issue with a secondary identifier for the ordering provider, such as missing or invalid details.

Remark code N268 indicates an issue with a claim due to missing or incorrect ordering provider contact details.

Remark code N269 indicates an issue with a claim due to a missing or incorrect other provider's name.

Remark code N270 indicates an issue with a missing or incorrect primary identifier for another provider on a claim.

Remark code N271 indicates an issue with a secondary provider's identifier, such as missing or invalid details, requiring correction.

Remark code N272 indicates an issue with a secondary payer's attending provider identifier, such as missing or invalid details.

Remark code N273 indicates an issue with a secondary payer's provider ID, requiring correction for claim processing.

Remark code N274 indicates an issue with a secondary payer's provider identifier, requiring correction for claim processing.

Remark code N275 indicates an issue with a secondary payer's service provider identifier, requiring correction for claim processing.

Remark code N276 indicates an issue with a secondary payer's referring provider identifier, requiring correction for claim processing.

Remark code N277 indicates an issue with the secondary payer's provider ID, such as missing or incorrect information.

Remark code N278 indicates an issue with the other payer's service facility provider identifier, such as it being missing or invalid.

Remark code N279 indicates a claim issue due to a missing or incorrect pay-to provider name, requiring correction for payment.

Remark code N280 indicates an issue with the pay-to provider's primary identifier, such as it being missing, incomplete, or invalid.

Remark code N281 indicates a claim issue due to a missing or invalid pay-to provider address, requiring correction for payment.

Remark code N282 indicates a claim was denied due to a missing or incorrect secondary identifier for the pay-to provider.

Remark code N283 indicates a claim issue due to a missing or invalid service provider identifier, requiring correction.

Remark code N284 indicates an issue with the claim: the referring provider's taxonomy is missing, incomplete, or invalid.

Remark code N285 indicates a claim issue due to missing or incorrect referring provider name, requiring action for resolution.

Remark code N286 indicates an issue with the missing or incorrect primary identifier for the referring provider.

Remark code N287 indicates an issue with a missing or incorrect secondary identifier for the referring provider.

Remark code N288 indicates an issue with the claim: the rendering provider's taxonomy code is missing, incomplete, or invalid.

Remark code N289 indicates an issue with the claim due to a missing or incorrect rendering provider name.

Remark code N290 indicates an issue with a provider's primary identifier, such as missing or incorrect details.

Remark code N291 indicates an issue with a secondary identifier for the rendering provider; it's either missing, incomplete, or invalid.

Remark code N292 indicates an issue with a claim due to a missing or invalid service facility name, requiring correction.

Remark code N293 indicates an issue with the service facility's primary identifier, such as missing or invalid details.

Remark code N294 indicates an issue with the claim: the address for the service facility is missing, incomplete, or invalid.

Remark code N295 indicates an issue with a missing or incorrect secondary identifier for the service facility in a claim.

Remark code N296 indicates an issue with a claim due to a missing or invalid supervising provider's name.

Remark code N297 indicates a claim issue due to a missing or invalid supervising provider's identifier.

Remark code N298 indicates an issue with a missing or incorrect secondary identifier for the supervising provider.

Remark code N299 indicates a claim rejection due to missing or incorrect occurrence date(s) on the submitted documentation.

Remark code N300 indicates an issue with claim submission due to missing or incorrect occurrence span dates.

Remark code N301 indicates a claim was denied due to missing, incomplete, or invalid procedure date(s).

Remark code N302 indicates an issue with the claim due to missing, incomplete, or invalid dates for other procedures.

Remark code N303 indicates an error due to a missing, incomplete, or invalid date for the principal procedure.

Remark code N304 indicates a claim issue due to a missing, incomplete, or invalid dispensed date.

Remark code N305 indicates the date of injury or accident is missing, incomplete, or invalid in the claim submission.

Remark code N306 indicates an error due to a missing, incomplete, or invalid date for an acute manifestation in a claim.

Remark code N307 indicates a claim issue due to a missing, incomplete, or invalid adjudication or payment date.

Remark code N308 indicates a claim was denied due to a missing, incomplete, or invalid appliance placement date.

Remark code N309 indicates an error due to a missing, incomplete, or invalid assessment date in the claim submission.

Remark code N310 indicates a claim issue due to a missing, incomplete, or invalid date for when care was assumed or relinquished.

Remark code N311 indicates an issue with a claim due to a missing, incomplete, or invalid date for authorized return to work.

Remark code N312 indicates a claim issue due to a missing, incomplete, or invalid begin therapy date, requiring correction.

Remark code N313 indicates a claim was denied due to a missing, incomplete, or invalid certification revision date.

Remark code N314 indicates a claim denial due to a missing, incomplete, or invalid diagnosis date on the submitted form.

Remark code N315 indicates a claim was denied due to missing, incomplete, or invalid disability from date information.

Remark code N316 indicates a claim was denied due to missing, incomplete, or invalid disability end date information.

Remark code N317 indicates a claim was denied due to missing, incomplete, or invalid discharge hour information.

Remark code N318 indicates a claim was denied due to a missing, incomplete, or invalid discharge or end of care date.

Remark code N319 is an alert for missing or incorrect hearing/vision prescription dates in healthcare claims.

Remark code N320 indicates a claim issue due to missing, incomplete, or invalid Home Health Certification Period details.

Remark code N321 indicates a claim issue due to a missing, incomplete, or invalid last admission period.

Remark code N322 is an alert indicating the last certification date is missing, incomplete, or invalid in a claim submission.

Remark code N323 indicates a claim issue due to a missing, incomplete, or invalid last contact date, requiring correction for processing.

Remark code N324 indicates a claim issue due to a missing, incomplete, or invalid last seen or visit date.

Remark code N325 indicates a claim issue due to a missing, incomplete, or invalid last worked date, requiring correction.

Remark code N326 indicates a claim issue due to a missing, incomplete, or invalid last x-ray date, requiring correction.

Remark code N327 indicates an issue with a claim due to a missing, incomplete, or invalid birth date for another insured individual.

Remark code N328 indicates a claim issue due to a missing, incomplete, or invalid Oxygen Saturation Test date.

Remark code N329 indicates a claim issue due to a missing, incomplete, or invalid patient birth date, requiring correction.

Remark code N330 indicates an issue with the patient's death date, either missing, incomplete, or invalid in the claim.

Remark code N331 indicates a claim issue due to a missing, incomplete, or invalid physician order date, requiring correction.

Remark code N332 indicates an issue with the claim due to a missing, incomplete, or invalid prior hospital discharge date.

Remark code N333 indicates a claim issue due to a missing, incomplete, or invalid prior placement date.

Remark code N334 is an alert for a missing, incomplete, or invalid re-evaluation date in healthcare billing documents.

Remark code N335 indicates a claim issue due to a missing, incomplete, or invalid referral date, requiring correction.

Remark code N336 indicates a claim issue due to a missing, incomplete, or invalid replacement date, requiring correction.

Remark code N337 indicates a claim issue due to a missing, incomplete, or invalid date for a secondary diagnosis.

Remark code N338 indicates a claim issue due to a missing, incomplete, or invalid shipped date, requiring correction for processing.

Remark code N339 indicates a claim denial due to a missing, incomplete, or invalid date for a similar illness or symptom.

Remark code N340 indicates a claim issue due to a missing, incomplete, or invalid subscriber birth date.

Remark code N341 indicates a claim denial due to a missing, incomplete, or invalid surgery date on the submitted documentation.

Remark code N342 indicates a claim issue due to a missing, incomplete, or invalid date for the test performed.

Remark code N343 indicates a claim issue due to a missing or invalid TENS trial start date, requiring correction for processing.

Remark code N344 indicates an issue with the TENS trial end date, such as it being missing, incomplete, or invalid in the claim.

Remark code N345 indicates the date range provided does not match the units submitted in the claim.

Remark code N346 is an alert for missing or incorrect oral cavity designation code in healthcare claims processing.

Remark code N347 indicates a claim for a referred or purchased service was denied due to prior payment for the same service by another provider.

Remark code N348 indicates a service, supply, or drug was designated to be provided and billed by another practitioner or supplier.

Remark code N349 indicates that both the drug and its administration method need to be documented for the service to be processed.

Remark code N350 indicates a claim was denied due to missing or invalid service descriptions for NOC codes or unlisted procedures.

Remark code N351 indicates a claim denial because the service date falls outside the approved treatment plan dates.

Remark code N352 alerts providers that no payments are scheduled for a service and advises submitting a claim for each patient visit.

Remark code N353 is an alert that benefits are estimated and may adjust after actual services are billed.

Remark code N354 indicates an issue with a claim due to an incomplete or invalid invoice, requiring correction for processing.

Remark code N355 is an alert indicating exceptions to refund requirements under specific conditions related to service payment denials.

Remark code N356 is an alert that a service isn't covered if done with or after a non-covered procedure.

Remark code N357 indicates that the necessary time gap between related healthcare services or supplies was not adhered to.

Remark code N358 alerts healthcare providers that a decision may be reconsidered with submission of further documentation as specified.

Remark code N359 is an alert indicating the patient's height information is missing, incomplete, or invalid in the claim.

Remark code N360 is an alert indicating benefits were estimated without coordination of benefits. Submit primary payer info with the secondary claim.

Remark code N362 indicates that the submitted days or units of service surpass the maximum allowed by the payer.

Remark code N363 alerts healthcare providers about upcoming policy/procedure changes that may impact claim determinations.

Remark code N364 indicates that, per the agreement, deductible and/or coinsurance amounts must be waived by the provider.

Remark code N366 is a notice that a claim was denied due to missing information, but can be reopened if the required details are submitted within one year.

Remark code N367 indicates a claim has been sent to a Consumer Spending Account processor, such as an FSA or HSA, for review.

Remark code N368 is an instruction for providers to appeal a decision on a previously adjudicated claim for resolution.

Remark code N369 indicates a processed claim is deficient as per state legislation/regulation, requiring further action.

Remark code N370 indicates billing surpasses the rental months authorized by the insurance, requiring review or adjustment.

Remark code N371 indicates that the equipment's ownership must be transferred to the patient.

Remark code N372 indicates that only charges deemed reasonable and necessary for maintenance or service are covered by insurance.

Remark code N373 indicates a refund to the payer who incorrectly paid services as primary, due to another payer being identified as primary.

Remark code N374 indicates Medicare Part A benefits are depleted; a Part B Remittance Advice is now necessary for processing.

Remark code N375 indicates a claim issue due to missing or invalid information needed to verify dependent eligibility.

Remark code N376 indicates when a patient is on active military duty, making TRICARE the primary insurance coverage.

Remark code N377 indicates payment adjustments were made based on a processed replacement claim.

Remark code N378 indicates a claim issue due to a missing, incomplete, or invalid prescription quantity on the submission.

Remark code N379 indicates a discrepancy between claim and line level information, requiring review for accurate processing.

Remark code N380 indicates the original claim was processed; providers should submit a corrected claim for further review.

Remark code N381 is an alert to review contractual agreements for specific billing and payment rules related to charges.

Remark code N382 is an alert for missing or incorrect patient ID details in healthcare billing documents.

Remark code N383 is an explanation for services not covered due to being considered cosmetic by the insurer.

Remark code N384 is an alert that the claimed service for a previously removed body part/tooth cannot be processed.

Remark code N385 indicates a claim issue due to untimely admission notification as per the plan's procedures.

Remark code N386 indicates a decision based on a National Coverage Determination (NCD), outlining coverage for specific services or items.

Remark code N387 is a notification to submit the claim to the patient's secondary insurer for possible supplemental benefits payment.

Remark code N388 indicates a claim issue due to a missing, incomplete, or invalid prescription number.

Remark code N389 is an alert indicating a duplicate prescription number has been submitted in a claim.

Remark code N390 indicates that the service or report provided cannot be billed as a separate charge.

Remark code N391 indicates a claim denial due to missing emergency department records, requiring submission for processing.

Remark code N392 is an alert indicating that emergency department records are incomplete or invalid, requiring attention.

Remark code N393 indicates a claim denial due to the absence of required progress notes or reports.

Remark code N394 is an alert indicating the submission of incomplete or invalid progress notes or reports in billing.

Remark code N395 is an alert indicating a claim's denial due to the absence of the required laboratory report.

Remark code N396 is an alert indicating an incomplete or invalid lab report, requiring review for accurate healthcare billing.

Remark code N397 indicates benefits are denied for services/items not fully provided or delivered.

Remark code N398 is an alert indicating a claim's denial due to a missing elective consent form, requiring action.

Remark code N399 indicates an issue with the elective consent form, either due to it being incomplete or invalid.

Remark code N400 indicates that providers capable of electronic submissions should file claims digitally for efficiency.

Remark code N401 is an alert indicating the absence of required periodontal charting in a claim submission.

Remark code N402 is an alert for healthcare providers about incomplete or invalid periodontal charting in billing documents.

Remark code N403 indicates a claim was denied due to the absence of necessary facility certification documentation.

Remark code N404 is an alert indicating the facility's certification is either incomplete or invalid, requiring attention.

Remark code N405 is an explanation that a service is covered only if the donor's insurers do not cover it.

Remark code N406 indicates a service is covered only if the recipient's insurers do not offer coverage for this specific service.

Remark code N407 indicates that the sender is not authorized to submit claims in the specified transmission format.

Remark code N408 is an explanation that the current insurer does not cover deductibles charged by another payer.

Remark code N409 indicates a service linked to an accidental injury is not covered unless it's within a certain time from the accident date.

Remark code N410 is an indication that a service is not covered unless there is a change in the prescription.

Remark code N411 indicates a service is permitted once every 6 months, highlighting claim limitations for healthcare providers.

Remark code N412 indicates a limit of 2 allowances for this service within a 12-month period, guiding billing adjustments.

Remark code N413 is an alert indicating a service is covered twice in a benefit year, guiding billing adjustments.

Remark code N414 indicates a limit of 4 allowances for this service within a 12-month period, guiding billing adjustments.

Remark code N415 indicates a limitation: the service is permitted only once within an 18-month timeframe.

Remark code N416 indicates a limitation: the service is permitted only once every three years.

Remark code N417 is an alert that a service is approved only once every 5 years, indicating billing limitations.

Remark code N418 is an alert that a claim was sent incorrectly. Review the payer's submission guidelines for proper routing.

Remark code N419 is an explanation for claim adjustments due to payer's retroactive rate changes.

Remark code N420 indicates a claim payment adjustment due to a retroactive Coordination of Benefits or Third Party Liability Recovery.

Remark code N421 indicates a claim payment adjustment following a payer's review organization decision for retroactive changes.

Remark code N422 indicates a claim payment adjustment due to a retroactive change from a payer's contract incentive program.

Remark code N423 indicates a claim payment adjustment by the payer, due to a retroactive change from a non-standard program.

Remark code N424 indicates a payment denial because the patient's residence is outside the required geographic area.

Remark code N425 indicates a service is not covered by insurance as it's legally excluded from coverage.

Remark code N426 is an explanation for denied insurance claims due to self-administered medication lacking coverage.

Remark code N427 indicates payment for eyeglasses or contact lenses is approved only post-cataract surgery.

Remark code N428 is an explanation for services not covered at the specified location.

Remark code N429 is an indicator that a service is not covered by insurance when it is deemed routine.

Remark code N430 indicates that the procedure code does not match the number of units billed, suggesting a billing error.

Remark code N431 indicates a service isn't covered when paired with the specific procedure performed.

Remark code N432 is an alert indicating an adjustment made due to a Recovery Audit finding in healthcare billing.

Remark code N433 is a notification to resubmit a claim with the provider's exclusive National Provider Identifier (NPI) only.

Remark code N434 is an alert for missing or invalid Present on Admission indicators in healthcare claims documentation.

Remark code N435 is an alert that claims exceed the approved number/frequency within a time period without proper documentation.

Remark code N436 indicates that the injury claim is pending acceptance, yet a compulsory medical payment has been processed.

Remark code N437 indicates that if the injury claim is accepted, the charges in question will be reconsidered for payment.

Remark code N438 is an alert that only paper claims are accepted in this specific jurisdiction, impacting claim processing.

Remark code N439 is an alert indicating the absence of required anesthesia physical status report/indicators in a claim.

Remark code N440 is an alert for healthcare providers about incomplete or invalid anesthesia status reports.

Remark code N441 indicates that the insurance does not cover missed or cancelled appointments.

Remark code N442 is an indication that payment was adjusted according to an alternative fee schedule.

Remark code N443 is an alert for missing or incorrect total time or session start/end times on a claim submission.

Remark code N444 is an alert indicating a facility hasn't filed the Election for High Cost Outlier form with the Division of Workers' Compensation.

Remark code N445 indicates a claim denial due to missing documentation for the actual cost or paid amount.

Remark code N446 is an alert indicating missing or incorrect documentation for the actual cost or payment amount.

Remark code N447 indicates payment adjustment due to lack of required documentation for brand-name medication, opting for a generic equivalent.

Remark code N448 indicates a drug, service, or supply not covered under the fee schedule or contracted fee arrangements.

Remark code N449 is an explanation for payment adjustments based on the cost of a comparable drug, service, or supply.

Remark code N450 is an explanation that a service is covered only if done by the primary physician or their designee.

Remark code N451 indicates a claim denial due to the absence of the required Admission Summary Report.

Remark code N452 is an alert indicating the Admission Summary Report is incomplete or invalid, requiring attention for claim processing.

Remark code N453 is an alert indicating a claim's denial due to the absence of a required consultation report.

Remark code N454 is an alert indicating a claim's denial due to an incomplete or invalid consultation report.

Remark code N455 is an alert indicating a claim was denied due to a missing physician order, requiring submission for processing.

Remark code N456 is an alert indicating the need for a complete or valid physician order in healthcare billing.

Remark code N457 is an alert indicating a claim's denial due to the absence of the required diagnostic report.

Remark code N458 is an alert indicating the diagnostic report submitted is incomplete or invalid, requiring review or correction.

Remark code N459 is an alert indicating a claim's rejection due to the absence of a discharge summary.

Remark code N460 is an alert indicating the discharge summary provided is either incomplete or invalid for processing.

Remark code N461 is an alert indicating that nursing notes required for billing are missing from the documentation.

Remark code N462 is an alert indicating the submission of incomplete or invalid Nursing Notes in a claim.

Remark code N463 is an alert indicating a claim lacks necessary supporting documentation for processing.

Remark code N464 indicates a claim has been denied due to missing or incorrect supporting documentation.

Remark code N465 indicates a claim denial due to missing physical therapy notes or reports, requiring submission for processing.

Remark code N466 is an alert indicating the submission of incomplete or invalid Physical Therapy Notes/Report.

Remark code N467 indicates a claim denial due to the absence of required tests and analysis reports in the submission.

Remark code N468 is an alert for healthcare providers about incomplete or invalid test and analysis reports in billing submissions.

Remark code N469 indicates a claim/service is under appeal as per section 935 of the 2003 Medicare Modernization Act.

Remark code N470 indicates that the payment issued will fulfill the required medical reimbursement cap.

Remark code N471 is an alert for missing or incorrect HIPPS Rate Code in healthcare billing submissions.

Remark code N472 indicates that payment for the service was made to a different provider.

Remark code N473 is an alert indicating a claim's denial due to the absence of required certification documentation.

Remark code N474 indicates an issue with a claim due to incomplete or invalid certification documentation provided.

Remark code N475 indicates a claim denial due to the absence of a completed referral form.

Remark code N476 indicates an issue with a referral form, specifically that it's incomplete or invalid, requiring attention.

Remark code N477 indicates that a claim was denied due to missing dental models required for processing.

Remark code N478 is an alert indicating the submission of incomplete or invalid dental models in a claim.

Remark code N479 is an alert indicating the absence of an Explanation of Benefits for Coordination or Medicare Secondary Payer details.

Remark code N480 indicates an incomplete or invalid Explanation of Benefits due to issues with Coordination of Benefits or Medicare Secondary Payer.

Remark code N481 indicates that the claim submission lacks necessary model information for processing.

Remark code N482 is an alert indicating the submission contains incomplete or invalid model information, requiring review.

Remark code N485 indicates a claim denial due to the absence of required Physical Therapy Certification documentation.

Remark code N486 is an alert indicating the Physical Therapy Certification submitted is incomplete or invalid.

Remark code N487 indicates a claim denial due to missing certification for prosthetics or orthotics.

Remark code N488 is an alert for healthcare providers about missing or incorrect certification for prosthetics or orthotics claims.

Remark code N489 is an alert indicating a claim denial due to the absence of a required referral form.

Remark code N490 indicates an issue with a referral form due to it being incomplete or invalid, requiring attention for claim processing.

Remark code N491 indicates an issue with the Exclusionary Rider Condition, either missing, incomplete, or invalid.

Remark code N492 indicates a provider can bill a patient if there was prior written agreement for responsibility of service charges.

Remark code N493 is an alert indicating the initial injury report from the doctor is missing from the claim documentation.

Remark code N494 indicates an error due to an incomplete or invalid Doctor's First Report of Injury submission.

Remark code N495 is an alert indicating a claim's denial due to the absence of a required supplemental medical report.

Remark code N496 is an alert indicating a submitted claim's Supplemental Medical Report is incomplete or invalid.

Remark code N497 indicates a claim was denied due to a missing Medical Permanent Impairment or Disability Report.

Remark code N498 is an alert for missing or incorrect Medical Permanent Impairment or Disability Report details in claims.

Remark code N499 is an alert indicating the absence of a required medical legal report in the claim submission.

Remark code N500 is an alert indicating the Medical Legal Report submitted is incomplete or invalid, requiring attention.

Remark code N501 is an alert indicating a vocational report is missing from the submitted documentation.

Remark code N502 is an alert indicating the Vocational Report submitted is incomplete or invalid, requiring attention.

Remark code N503 is an alert indicating the absence of a required Work Status Report in a healthcare claim submission.

Remark code N504 is an alert indicating the Work Status Report is either incomplete or invalid, requiring attention.

Remark code N505 indicates services estimated in real-time are included in the response, but no estimate is available for non-real-time services.

Remark code N506 is an estimate of member liability, not a pre-authorization or payment guarantee. Actual amounts determined upon claim processing.

Remark code N507 indicates that the distance requirements set by the insurance plan have not been fulfilled.

Remark code N508 indicates the patient's financial responsibility for services, as determined by real-time claim adjudication. Members will receive an EOB for details.

Remark code N509 indicates funds are available in the member's Consumer Spending Account to cover liability, but payment depends on fund availability and service eligibility.

Remark code N510 is an alert indicating insufficient funds in the member's Consumer Spending Account for the claim/service.

Remark code N511 is an alert indicating Consumer Spending Account fund availability for member liability on a claim is currently unknown.

Remark code N512 is an alert for the first remittance of a non-NCPDP claim initially submitted in real-time, with no adjudication changes.

Remark code N513 is an alert for the first remittance of a non-NCPDP claim initially submitted in real-time, now with adjudication changes.

Remark code N516 is an alert that the submitted National Provider Identifier and Employer Identification Number do not match.

Remark code N517 is an instruction to resubmit a new claim with the specified additional information for processing.

Remark code N518 is a notice that accessories provided with oxygen equipment are not paid for separately by insurers.

Remark code N519 is an alert indicating an error due to incompatible HCPCS modifiers used in a claim submission.

Remark code N520 indicates a payment was made using a Consumer Spending Account, affecting claim processing.

Remark code N521 is an alert indicating a discrepancy between the provider details submitted and those on record.

Remark code N522 is an alert that a claim is a duplicate of one already processed or pending as a crossover claim.

Remark code N523 indicates the payer's outlier payment limit for this service period has been reached, thus no outlier payment for this claim.

Remark code N524 indicates that the payment received is considered final as per the policy guidelines.

Remark code N525 indicates services aren't covered if performed during another service's global period.

Remark code N526 is an explanation that the claim isn't eligible for recovery due to the employer's size.

Remark code N527 is an explanation that the claim was processed as primary before a recovery demand was received.

Remark code N528 indicates that the patient's insurance covers only institutional services, not individual treatments.

Remark code N529 is an alert indicating the patient's coverage is limited to professional services only.

Remark code N530 is an alert that recovery is not possible due to enrollment details.

Remark code N531 is an explanation that recovery is not possible due to direct premium payments by the insured.

Remark code N532 is an explanation for denial, indicating ineligibility for recovery due to disability/work status.

Remark code N533 is an indicator for services rendered in an Indian Health Services facility under a tribal self-insured Group Health Plan.

Remark code N534 is an alert that the policy is individual, not employer-sponsored.

Remark code N535 is an adjustment notice for payments when a procedure's code and service location affect the reimbursement amount.

Remark code N536 is an explanation that the prior payer's patient responsibility decision remains unchanged, allowing collection for uncovered services.

Remark code N537 is an alert indicating that after reviewing claims history, no records of the provided services were found.

Remark code N538 is an alert that payment for services/supplies/drugs by outside providers is the facility's responsibility.

Remark code N539 is an alert indicating that appeals or waiver requests processed on behalf of the provider have been denied.

Remark code N540 is an adjustment notice for payments affected by the interrupted stay policy in healthcare billing.

Remark code N541 is an alert indicating a discrepancy between the insurance type code submitted and our records.

Remark code N542 is an alert indicating that the patient's income verification is missing from their documentation.

Remark code N543 is an alert indicating the need for complete or valid income verification in healthcare billing.

Remark code N544 is an alert that payment was made despite a mismatch in the referring/ordering provider details, warning of future denial if uncorrected.

Remark code N545 is an alert indicating payment reduction due to the provider's status as an unsuccessful e-prescriber under the eRx Incentive Program.

Remark code N546 is an explanation for reduced payment due to prior adjustments from the eRx Incentive Program.

Remark code N547 indicates a previously processed refund request associated with Frequency Type Code 8.

Remark code N548 indicates the patient's annual deductible is fulfilled, impacting claim processing and payment.

Remark code N549 indicates the patient's yearly out-of-pocket expense limit has been reached, impacting billing.

Remark code N550 alerts providers that failure to revalidate enrollment info will soon lead to a payment hold.

Remark code N551 is an adjustment notice for payments based on the ASC Quality Reporting Program criteria.

Remark code N552 is an adjustment notice reversing a prior withhold or bonus, impacting your payment balance.

Remark code N554 is an alert indicating the absence or error in the Family Planning Indicator on a claim submission.

Remark code N555 is an alert indicating a claim's denial due to an absent medication list, requiring submission for processing.

Remark code N556 is an alert indicating the medication list provided is either incomplete or invalid, requiring attention.

Remark code N557 indicates a claim/service is not payable due to being outside the service area. It must be filed to the correct Payer/Plan.

Remark code N558 is an alert that the claim isn't payable in the current service area and must be filed to the correct Payer/Plan.

Remark code N559 is an alert that the claim isn't payable in the current service area and must be filed to the correct Payer/Plan.

Remark code N560 is an alert that a claim must be submitted within 60 days of admission, as per the pilot program's rules.

Remark code N561 indicates a bundled claim for an episode of care includes related readmissions, allowing resubmission for corrected payment.

Remark code N562 is an alert that the provider number on your claim doesn't match the NOA's provider number for bundled payment.

Remark code N563 is an alert indicating a provider's failure to issue advance notice of non-coverage, absolving the patient from payment responsibility.

Remark code N564 is an explanation that the patient didn't qualify for the specific demo project or pilot program.

Remark code N565 alerts that a non-payable reporting code needs a modifier. Future claims must include it for processing.

Remark code N566 alerts that a procedure code needs functional reporting. Future claims must have a non-payable code and modifiers for processing.

Remark code N567 is an explanation for services not covered due to their preventative nature.

Remark code N568 is an alert for initial payment based on the Notice of Admission under the Bundled Payment Model IV initiative.

Remark code N569 is an explanation that a service isn't covered due to the specific diagnosis reported.

Remark code N570 indicates missing, incomplete, or invalid credentialing data in healthcare billing submissions.

Remark code N571 indicates that payment will be made quarterly by a different payer or contractor, affecting claim processing.

Remark code N572 indicates a procedure is not payable without the correct non-payable reporting codes and modifiers.

Remark code N573 is an alert indicating an overpayment has been made and a refund is required, with a separate request from another payer.

Remark code N574 indicates the provider's type/specialty cannot order/refer. Verify claim info or contact the provider for accuracy.

Remark code N575 is an alert indicating a discrepancy between the submitted and recorded names of the ordering/referring provider.

Remark code N576 indicates services billed are unrelated to the incident/claim/accident/loss specified in the report.

Remark code N577 indicates that the claim involves Personal Injury Protection (PIP) Coverage.

Remark code N578 is an explanation from insurers indicating the provided coverages do not apply to the specific claim submitted.

Remark code N579 is an indicator that the claim involves Medical Payments Coverage (MPC) issues.

Remark code N580 is an explanation for insurance claim decisions based on specific policy provisions.

Remark code N581 indicates that the investigation into the patient's coverage eligibility is currently ongoing.

Remark code N582 is an alert that benefits are on hold until the patient provides necessary cooperation.

Remark code N583 indicates coverage denial as the patient wasn't an occupant of the insured vehicle, thus ineligible for benefits.

Remark code N584 is an indication that a service is not covered due to the insured's failure to meet policy conditions.

Remark code N585 is an alert that benefits have ceased due to a final injury settlement.

Remark code N586 is an alert indicating the injured party is ineligible for benefits due to qualification criteria.

Remark code N587 indicates that the patient's insurance policy benefits have been fully used up.

Remark code N588 indicates that the patient has directed that their medical claims or bills should not be processed for payment.

Remark code N589 is an explanation for denied insurance coverage due to injuries from operating a vehicle under the influence.

Remark code N590 is an alert indicating the absence of an independent medical exam report detailing injury causes and service necessity.

Remark code N591 is an indication that payment is adjusted based on an Independent Medical Examination (IME) or Utilization Review (UR).

Remark code N592 is an adjustment notice for prescriptions not initial or exceeding the allowed amount for the first prescription.

Remark code N593 is an indication that a claim isn't covered due to missing a scheduled Independent Medical Exam (IME).

Remark code N594 is an alert indicating the injured party failed to complete a Benefits Application for the reported loss.

Remark code N595 indicates the injured party failed to complete an Assignment of Benefits for the reported loss.

Remark code N596 indicates the injured party failed to complete a Medical Authorization for the reported loss.

Remark code N597 is an adjustment due to the division of care costs between related injuries and other unrelated health conditions.

Remark code N598 is an indicator that the patient's health care policy is the primary coverage for billing purposes.

Remark code N599 indicates payment is based on a reasonable amount, considering usual charges, policy terms, and the Florida No-Fault Statute, at 200% of Medicare Part B fees.

Remark code N600 is an adjustment notice indicating billing aligns with the regional fee schedule where service was provided.

Remark code N601 is a notification that payment aligns with Hawaii's specific Medicare Resource Based Relative Value Scale System.

Remark code N602 is an adjustment notice indicating billing exceeds the Redbook's maximum allowed price for a service or item.

Remark code N603 indicates the fee is based on New Jersey's medical schedules for Auto Injury Protection and Motor Bus Medical Coverage.

Remark code N604 is an explanation for a base fee adjustment in NY, calculated as per Regulation 68, following the NY Workers' Compensation Board Schedule.

Remark code N605 is an explanation that the fee was set based on NY APR-DRG, as required by Regulation 68.

Remark code N606 indicates the Oregon allowed amount for a procedure is based on the Workers Compensation Fee Schedule, as per ORS 742.524.

Remark code N607 is an alert indicating service was for a condition not covered by the insurance plan.

Remark code N608 indicates the fee allowed is 110% of the Medicare Fee Schedule for the region, specialty, and service, in line with Act 6.

Remark code N609 indicates that 80% of the billed amount is recommended for payment as per Act 6 guidelines.

Remark code N610 indicates payment adjustments due to services not matching the required care level.

Remark code N611 indicates a claim is under litigation. Providers should contact the insurer for further details.

Remark code N612 is an alert that the provider is not certified to treat injured workers in the specified area.

Remark code N613 is an alert that payment was made, but the ordering provider's enrollment needs updating. Verify and act to ensure future payments.

Remark code N614 is an alert indicating extra details are in the 835 Healthcare Policy ID Segment, loop 2110 Service Payment Info.

Remark code N615 is an alert indicating an enrollee in a 3-month grace period for premium non-payment, with specific claim handling rules.

Remark code N616 alerts healthcare providers that the enrollee is in the first month of their advance premium tax credit grace period.

Remark code N617 indicates an enrollee is in the 2nd or 3rd month of the advance premium tax credit grace period.

Remark code N618 alerts healthcare providers that the claim will be reprocessed once the enrollee pays their premiums.

Remark code N619 is an alert indicating insurance coverage was ended due to unpaid premiums.

Remark code N620 alerts that the procedure code is used solely for quality reporting or informational purposes, not billing.

Remark code N621 indicates that charges for required forms, reports, or chart notes by jurisdiction are not covered.

Remark code N622 is an explanation for services not covered due to the date of the injury or accident.

Remark code N623 is an explanation for denial, indicating a service is not covered due to being unproven or inappropriate.

Remark code N624 indicates the related Workers' Compensation claim has been retracted by the claimant or payer.

Remark code N625 indicates a claim issue due to a missing, incomplete, or invalid Workers' Compensation Claim Number.

Remark code N626 indicates E/M codes for new or established patients are not billable alongside chiropractic care codes.

Remark code N628 indicates that follow-up outpatient visits on the same day as a scheduled test or treatment are not permitted.

Remark code N629 indicates that additional reviews, documentation, notes, summaries, reports, or charts were not requested.

Remark code N630 indicates a claim denial due to lack of referral authorization from the attending physician.

Remark code N631 indicates a service code isn't listed in the Medical Fee Schedule, but an allowance was made for a similar service.

Remark code N633 is an alert that extra time units for anesthesia services are not permitted in billing.

Remark code N634 is an explanation that payment is based on calculated anesthesia time units.

Remark code N635 is an explanation for how anesthesia allowances are determined by base units and time.

Remark code N636 is an adjustment notice indicating a service is only reimbursable once per injury.

Remark code N637 is an alert that consultations by the same provider post-treatment are not permitted for billing.

Remark code N638 indicates payment was adjusted based on the home health fee schedule.

Remark code N639 indicates payment was aligned with the inpatient rehab facility fee schedule.

Remark code N640 indicates a claim exceeds the number or frequency of services approved or allowed within a specific time period.

Remark code N641 is an explanation for reimbursement based on the rated body areas.

Remark code N642 is an adjustment for billing individual tests rather than as a panel, affecting reimbursement.

Remark code N643 indicates services billed are not covered in the state's fee schedule, meaning they're ineligible for payment.

Remark code N644 indicates payment was adjusted following the bilateral procedure rule, affecting reimbursement amounts.

Remark code N645 is an indication that a mark-up allowance has been applied to the healthcare service billing.

Remark code N646 indicates reimbursement adjustment due to assistant guidelines.

Remark code N647 is an adjustment notice indicating billing changes based on the diagnosis-related group (DRG) classification.

Remark code N648 is an adjustment notice indicating billing reached the stop loss limit set by the payer's policy.

Remark code N649 is an indication that payment was determined according to the submitted invoice details.

Remark code N650 indicates a claim denial because the policy was inactive on the date of the incident. Coverage is unavailable.

Remark code N651 indicates a lack of Personal Injury Protection/Medical Payments Coverage in the policy during the loss event.

Remark code N652 is an alert indicating the service date precedes the loss date, requiring verification or correction.

Remark code N653 is an alert that the injury date and reported loss date do not align, requiring verification.

Remark code N654 is an adjustment notice indicating maximum medical improvement (MMI) has been achieved, affecting payment.

Remark code N655 is an explanation for payment adjustments based on the provider's geographic location.

Remark code N656 indicates an interest payment due to benefits paid beyond the statutory requirement.

Remark code N657 is an alert indicating services must be billed with the correct procedural code for acceptance.

Remark code N658 is an alert that the billed services are not recognized as medical expenses by the payer.

Remark code N659 indicates an item is not subject to sales tax, clarifying billing and payment processing for healthcare providers.

Remark code N660 indicates that the reimbursement amount already includes sales tax.

Remark code N661 indicates that the provided documentation fails to prove the medical necessity of the services billed.

Remark code N662 is an alert indicating payment consideration awaits the submission of a final bill.

Remark code N663 is an adjustment notice indicating a payment change due to a pre-negotiated agreement.

Remark code N664 is an adjustment due to a legal settlement affecting the claim's reimbursement.

Remark code N665 indicates that services from an unlicensed provider are not eligible for reimbursement.

Remark code N666 indicates that only one evaluation and management code at this service level is covered during the care course.

Remark code N667 is an alert indicating a claim's denial due to the absence of a required prescription.

Remark code N668 indicates an incomplete or invalid prescription, signaling a need for additional information or correction.

Remark code N669 is an adjustment notice indicating billing was aligned with the Medicare fee schedule.

Remark code N670 indicates the service code is the primary procedure for Medicare's Multiple Procedure Payment Reduction rule.

Remark code N671 is an explanation for adjustments, indicating payment is aligned with the jurisdiction's cost-charge ratio.

Remark code N672 alerts that the specified amount has been applied to the Health Insurance Offset.

Remark code N673 indicates reimbursement is based on outpatient per diem, factor, or fee schedule amount, affecting payment calculations.

Remark code N674 is an alert that coverage is denied unless a specific prior procedure or service has been completed.

Remark code N675 indicates more details are needed from the injured party for claim processing.

Remark code N676 is an alert that a service is ineligible for payment under the Outpatient Facility Fee Schedule.

Remark code N677 is an alert indicating that submitted films/images will not be returned to the healthcare provider.

Remark code N678 is an alert indicating the absence of required post-operative images or visual field results in a claim submission.

Remark code N679 is an alert for healthcare providers about incomplete or invalid post-op images/visual field results.

Remark code N680 indicates an error due to missing, incomplete, or invalid dates of previous dental extractions.

Remark code N681 indicates a claim issue due to missing, incomplete, or invalid full arch series information.

Remark code N682 is an alert for missing or invalid prior periodontal therapy history in patient records.

Remark code N683 indicates a claim issue due to missing, incomplete, or invalid documentation of prior treatment.

Remark code N684 is an alert that payment was denied because a specialty claim was incorrectly submitted as a general claim.

Remark code N685 is an alert for missing or invalid prosthesis, crown, or inlay codes in healthcare billing submissions.

Remark code N686 is an alert indicating a questionnaire required for payment determination is missing, incomplete, or invalid.

Remark code N687 indicates a reversal of charges due to a patient's retroactive disenrollment from their insurance plan.

Remark code N688 is an alert indicating a reversal due to a medical or utilization review decision.

Remark code N689 is an alert indicating a payment reversal due to a retroactive adjustment in rates.

Remark code N690 alerts healthcare providers that a reversal has occurred as a result of an appeal they submitted.

Remark code N691 is an alert indicating a reversal in billing due to an appeal submitted by the patient.

Remark code N692 alerts that a reversal occurred due to an incorrect rate in the initial claim adjudication process.

Remark code N693 indicates a claim reversal initiated by the provider's cancellation of the claim.

Remark code N694 is an alert indicating a claim reversal due to provider's resubmission or change to the original claim.

Remark code N695 alerts that a reversal occurred due to wrong patient financial responsibility info initially adjudicated.

Remark code N696 alerts healthcare providers of a reversal due to Coordination of Benefits or Third Party Liability retroactive adjustment.

Remark code N697 is an alert indicating a reversal due to adjustments from a payer's retroactive contract incentive program.

Remark code N698 is an alert indicating coverage loss due to unpaid health insurance premiums after the grace period ends.

Remark code N699 is an adjustment notice for payments affected by the Physician Quality Reporting System Incentive Program.

Remark code N700 is an adjustment notice for payments based on compliance with the Electronic Health Records Incentive Program.

Remark code N701 is an adjustment notice indicating payment changes due to the Value-based Payment Modifier.

Remark code N702 is an alert indicating a decision was made based on review of past or ongoing claims for similar services.

Remark code N703 is an alert that the service billed conflicts with prior or pending claims, impacting payment.

Remark code N704 is a notification that appeals are not allowed, but corrected claim resubmission is possible if needed.

Remark code N705 indicates that a claim was denied due to incomplete or invalid documentation provided.

Remark code N706 indicates that a claim was denied due to missing documentation required for processing.

Remark code N707 indicates an issue with claims due to incomplete or invalid orders from healthcare providers.

Remark code N708 is an alert indicating that required orders are missing from the billing submission.

Remark code N709 indicates that the documentation or notes provided are incomplete or invalid for processing.

Remark code N710 is an alert indicating that payment or processing is delayed due to missing documentation or notes.

Remark code N711 is an alert indicating the summary provided is incomplete or invalid, requiring attention for claim processing.

Remark code N712 indicates a claim rejection due to the absence of a required summary document in the submission.

Remark code N713 indicates an insurance claim was denied due to an incomplete or invalid report submitted by the healthcare provider.

Remark code N714 is an alert indicating a required report is missing from the claim submission.

Remark code N715 is an alert indicating a claim's denial due to incomplete or invalid chart documentation.

Remark code N716 is an alert indicating a claim's processing delay due to the absence of the patient's medical chart.

Remark code N717 indicates invalid or missing documentation for a required face-to-face examination.

Remark code N718 indicates a claim denial due to missing documentation for a required face-to-face examination.

Remark code N719 indicates a penalty due to failure in meeting specific plan requirements.

Remark code N720 alerts healthcare providers that a patient has overpaid and may need a refund for the excess amount paid over their responsibility.

Remark code N721 indicates that coverage applies only if the service is part of a clinical trial.

Remark code N722 indicates that the patient needs to use Workers' Compensation Set-Aside funds for the medical service or item payment.

Remark code N723 is an alert that the patient must use Liability Set-Aside funds for the medical service or item payment.

Remark code N724 is an alert that payment should come from No-Fault set-aside funds for the specified medical service or item.

Remark code N725 indicates a liability insurer is responsible for ongoing medical services for the specified diagnosis.

Remark code N726 indicates a conditional payment is not permitted in the healthcare billing process.

Remark code N727 indicates a no-fault insurer is responsible for ongoing medical services for the specified diagnosis.

Remark code N728 indicates a workers' comp insurer is responsible for ongoing medical services for the specified diagnosis.

Remark code N729 is an alert indicating the absence of the patient's medical or dental record for a specific service.

Remark code N730 indicates an issue with the patient's medical/dental record being incomplete or invalid for the service provided.

Remark code N731 is an alert indicating an incomplete or invalid mental health assessment in healthcare billing.

Remark code N732 indicates that services at unlicensed facilities are not covered for reimbursement.

Remark code N733 is an indication that regulatory surcharges should be paid directly to the state by healthcare providers.

Remark code N734 indicates eligibility for medical services is based on inability to work or perform normal activities due to illness or injury.

Remark code N736 is an alert indicating the Sleep Study Report submitted is incomplete or invalid for processing.

Remark code N737 is an alert indicating a claim was denied due to the absence of a required sleep study report.

Remark code N738 is an alert indicating the Vein Study Report submitted is incomplete or invalid, requiring review or correction.

Remark code N739 is an alert indicating a claim's denial due to the absence of the required vein study report.

Remark code N740 indicates insufficient funds in a member's Consumer Spending Account to cover their liability for a specific claim or service.

Remark code N741 indicates a payment adjustment due to site-neutral policy, affecting reimbursement rates.

Remark code N743 is an adjustment notice indicating services might be linked to a work-related accident.

Remark code N744 is an adjustment notice indicating services might be linked to an auto or other accident, affecting coverage.

Remark code N745 is an alert indicating the absence of required ambulance report documentation in a claim submission.

Remark code N746 is an alert for healthcare providers about an incomplete or invalid Ambulance Report in billing submissions.

Remark code N747 indicates a misdirected claim/service. Providers should submit the claim to the payer/plan where the patient resides.

Remark code N748 is an adjustment notice indicating the absence of related hospital charge submissions.

Remark code N749 is an alert indicating a claim's denial due to the absence of a required blood gas report.

Remark code N750 is an alert indicating the Blood Gas Report submitted is incomplete or invalid, requiring review or correction.

Remark code N751 is an adjustment notice indicating coverage under a Medicare Part D plan, affecting claim processing.

Remark code N752 is an alert for missing or invalid HIPPS Treatment Authorization Code, indicating a need for correct submission.

Remark code N753 is an alert for missing, incomplete, or invalid Attachment Control Numbers in healthcare billing documents.

Remark code N754 is an alert for missing or invalid Referring Provider details on the 1500 Claim Form, requiring correction.

Remark code N755 is an alert for missing, incomplete, or invalid ICD Indicator in healthcare billing documents.

Remark code N756 is an alert for missing or incorrect drop-off address details in healthcare billing submissions.

Remark code N757 is an adjustment notice for healthcare providers, indicating billing aligned with the Federal Indian Fees schedule.

Remark code N758 is an adjustment notice indicating a decision based on prior authorization for healthcare providers.

Remark code N759 is an adjustment to payment based on compliance with NEMA Standard XR-29-2013 for imaging efficiency.

Remark code N760 indicates that the facility is not authorized to receive payment for the provided services.

Remark code N761 indicates that the provider lacks authorization to receive payment for the specified service(s).

Remark code N762 indicates that the facility lacks certification for Tomosynthesis (3-D) mammography services.

Remark code N763 is a notification that the demonstration code used is incorrect for the claim and advises resubmission without it.

Remark code N764 is an alert for missing or invalid Hematocrit (HCT) values in healthcare claims documentation.

Remark code N765 is an explanation that the payer does not cover coinsurance charged by another insurer.

Remark code N766 is an explanation that the payer does not cover co-payments assessed by another insurer.

Remark code N767 indicates a claim won't be processed until the provider enrolls in the Medicaid program of the member's state.

Remark code N768 indicates an incomplete or invalid initial evaluation report in healthcare billing.

Remark code N769 indicates a claim needs a specific lateral diagnosis to be processed correctly.

Remark code N770 indicates that the provider's adjustment request has been processed, leading to an adjustment of the original claim.

Remark code N771 alerts healthcare providers that charging beyond the federal limiting charge amount is prohibited by law.

Remark code N772 indicates to rebill urgent/emergent and ancillary services separately for correct processing.

Remark code N773 indicates that the drug was not purchased from a designated specialty vendor, impacting claim processing.

Remark code N774 is a notification to check your Third Party Processor Agreement for fees related to this payment type.

Remark code N775 is an adjustment notice indicating payment changes due to x-ray radiograph being on film.

Remark code N776 indicates that the service provided is not eligible for Telehealth coverage under the patient's plan.

Remark code N777 is an alert indicating the Assignment of Benefits Indicator is missing from a claim submission.

Remark code N778 is an alert indicating the absence of primary care physician details in a claim submission.

Remark code N779 is a notification that replacement or void claims must wait until the initial claim's final decision before resubmission.

Remark code N780 is an alert for a missing, incomplete, or invalid end therapy date in healthcare claims.

Remark code N781 alerts providers that the patient is a Medicaid/Medicare Beneficiary, advising a review of records for any incorrect deductible collections.

Remark code N782 is an alert that the patient is a Medicaid/Medicare Beneficiary, advising to check records for incorrect coinsurance charges.

Remark code N783 is a notification that the patient is on Medicaid/Medicare, advising to check for incorrect copays that might be billed elsewhere.

Remark code N784 is an alert indicating a claim lacks the required comprehensive procedure code for processing.

Remark code N785 is an alert indicating the absence of current radiology films or images required for claim processing.

Remark code N786 is an explanation for limited benefits during orthodontic treatment phases.

Remark code N787 alerts that PHP patients must receive a minimum of 20 hours weekly as per 42 CFR 410.43, following the care plan.

Remark code N788 is an alert indicating the third-party administrator or review organization lacks necessary information.

Remark code N789 indicates that services related to clinical trials are not included in the patient's insurance coverage benefits.

Remark code N790 indicates a provider or supplier lacks accreditation for the specific product or service billed.

Remark code N791 is an alert indicating a claim was denied due to the absence of a required history and physical report.

Remark code N792 is an alert indicating the history & physical report submitted is incomplete or invalid, requiring review.

Remark code N794 is an adjustment notice indicating payment changes due to the technology type utilized in treatment.

Remark code N795 indicates an item must be reprocessed as a purchase for proper billing and reimbursement.

Remark code N796 is an alert for healthcare providers about missing or invalid Hemoglobin values in documentation.

Remark code N797 indicates an error due to a missing, incomplete, or invalid date qualifier in a claim submission.

Remark code N798 is a notification to void the original claim and submit a new one for accurate processing.

Remark code N799 indicates that a claim's submitted identifier must be specific to an individual, not a group, for processing.

Remark code N800 is an alert that claims must contain only one service date, ensuring accurate billing and processing.

Remark code N801 is an indication that services were provided in a facility under a self-insured tribal Group Health Plan as per 42 CFR 136.

Remark code N802 is an alert that the claim isn't payable in the current service area and must be filed to the correct Payer/Plan.

Remark code N803 indicates that the claim should be submitted by the Contracted Medical Group or Hospital, not the individual provider.

Remark code N804 indicates the claim/service underwent processing via the Outpatient Code Editor (OCE) for evaluation.

Remark code N805 indicates the claim/service was reviewed for accuracy and processed using the Correct Code Editor (CCE).

Remark code N806 is an explanation that payment is part of the overall transplant allowance.

Remark code N807 is a payment adjustment notification related to the Merit-based Incentive Payment System (MIPS).

Remark code N808 indicates services not covered due to provider type/specialty. Essential for healthcare billing and claims adjustments.

Remark code N809 is an adjustment notice for services priced based on prior competitive bidding, advising to consult the local contractor for details.

Remark code N810 indicates a claim processed at in-network benefits due to a disaster declaration, with standard network rules reinstating post-declaration.

Remark code N811 is an alert indicating the absence of Federal Sequestration Reduction details from a previous insurer's payment.

Remark code N812 indicates that service dates must not exceed an 18-month span between start and end dates.

Remark code N815 is an alert for a claim issue due to a missing, incomplete, or invalid National Drug Code unit count.

Remark code N816 is an alert for missing or invalid National Drug Code (NDC) unit of measure in billing documents.

Remark code N817 is a notification for labs to collect & report private payor data to CMS from Jan 1 - Mar 31, 2020.

Remark code N818 indicates that the dates of service on a claim don't align with the Electronic Visit Verification System data.

Remark code N819 is an alert indicating the patient isn't enrolled in the Electronic Visit Verification System.

Remark code N820 indicates that the units submitted via Electronic Visit Verification don't meet the visit's required standards.

Remark code N821 is an alert indicating a visit was not recorded in the Electronic Visit Verification System.

Remark code N822 is an alert indicating that a claim was submitted without the required procedure modifier(s).

Remark code N823 is an alert indicating the procedure modifier(s) provided are incomplete or invalid, requiring correction.

Remark code N824 is an alert that EVV data needs submission through a specific EVV Vendor for processing.

Remark code N825 indicates that the claim was denied because early intervention guidelines were not met.

Remark code N826 is an alert indicating a patient's ineligibility for the Medicare Shared Savings Program due to criteria not met.

Remark code N827 indicates a claim was denied due to a missing, incomplete, or invalid Federal Information Processing Standard (FIPS) Code.

Remark code N828 is an alert indicating payment suppression due to contracted funding arrangements.

Remark code N829 is an alert for missing or invalid Diagnostics Exchange Z-Code Identifier in healthcare claims.

Remark code N830 indicates charges were processed following Federal/State regulations, preventing collection of certain amounts from the patient, with potential provider liability.

Remark code N831 is a notification that the provider's enrollment information revalidation request remains unanswered.

Remark code N832 is an alert indicating a duplicate occurrence or span code was submitted in a claim.

Remark code N833 indicates that the patient's share of cost has been waived by the insurer or provider.

Remark code N834 is an indicator that the service is exempt from jurisdictional sales and health tax charges.

Remark code N835 indicates a reduction in charges for unrelated services, treatments, or procedures, with the remaining balance being the patient's responsibility.

Remark code N836 indicates a provider's W9 or Payee Registration is missing from the file, requiring submission for processing.

Remark code N837 is an alert indicating a missing modifier has been added to ensure accurate billing and reimbursement.

Remark code N838 indicates a service was postponed due to a mandate or disaster, affecting deductible or liability calculations for the prior plan year.

Remark code N839 indicates a procedure code adjustment due to the service level exceeding the compensable conditions.

Remark code N840 indicates a worker's compensation claim was filed in another state, affecting claim processing.

Remark code N841 is an alert for compliance with North Dakota Administrative Rule 92-01-02-50.3 in healthcare billing.

Remark code N842 is an alert indicating that the patient should not be billed for specific charges.

Remark code N843 indicates a claim issue due to a missing, incomplete, or invalid Core-Based Statistical Area (CBSA) code.

Remark code N844 indicates a claim was processed per Nebraska's LB997 Act on July 24, 2020, for out-of-network emergency care.

Remark code N845 is an alert for the Nebraska Legislative LB997 Act on out-of-network emergency care, effective July 24, 2020.

Remark code N846 indicates the National Drug Code (NDC) provided does not match the HCPCS/CPT code billed.

Remark code N847 indicates the National Drug Code (NDC) billed is no longer current or valid.

Remark code N848 is an alert that the NDC billed does not match any recognized product, requiring verification.

Remark code N849 is an alert indicating a claim denial due to a tooth missing before the member's coverage start date.

Remark code N850 indicates a claim was denied due to missing, incomplete, or invalid narrative for the described service/treatment.

Remark code N851 indicates payment was decreased due to services being provided by a therapy assistant.

Remark code N852 indicates a discrepancy between the pay-to and rendering provider's tax identification numbers (TINs).

Remark code N853 indicates that the session had more modalities than the maximum allowed by the policy.

Remark code N854 indicates that if your primary other health insurance denies services, all appeal levels must be exhausted before claim reimbursement consideration.

Remark code N855 indicates coverage falls under ERISA (1974) jurisdiction, impacting claims and benefits management for providers.

Remark code N856 is an explanation that the coverage does not fall under ERISA (1974) jurisdiction, as per U.S.C. SEC 1001.

Remark code N857 indicates a claim adjustment or reversal. Providers should refund any copayments collected from the member.

Remark code N858 indicates state Out of Network Medical Emergency Care Act regulations affected this claim's processing, with dispute options available.

Remark code N859 is an alert that the No Surprise Billing Act affects this claim's processing, with payment disputes allowed.

Remark code N860 indicates the use of the Federal No Surprise Billing Act QPA to calculate member cost shares.

Remark code N861 alerts when there's a discrepancy between the submitted patient liability/share of cost and the recorded amount for this recipient.

Remark code N862 indicates compliance with the No Surprises Act, showing member cost share is based on the lesser of QPA or billed charge.

Remark code N863 indicates a claim falls under the No Surprises Act, with the final out-of-network rate set by an All Payer Model Agreement.

Remark code N864 is an alert indicating the claim falls under the No Surprises Act for emergency services.

Remark code N865 is an alert indicating the claim falls under the No Surprises Act for non-emergency services by non-participating providers.

Remark code N866 is an alert indicating the claim falls under the No Surprises Act for nonparticipating air ambulance services.

Remark code N867 indicates cost sharing was calculated based on state law, aligning with the No Surprises Act requirements.

Remark code N868 indicates cost sharing was calculated under an All-Payer Model Agreement as per the No Surprises Act.

Remark code N869 indicates cost sharing was based on the qualifying payment amount as per the No Surprises Act.

Remark code N870 is an alert indicating cost sharing was based on the billed amount, as it was lower than the qualifying payment amount, per the No Surprises Act.

Remark code N871 indicates an initial payment calculated as per a specific state law, aligning with the No Surprises Act requirements.

Remark code N872 indicates the final payment was adjusted based on state law, aligning with the No Surprises Act requirements.

Remark code N873 is an alert indicating final payment was based on an All-Payer Model Agreement under the No Surprises Act.

Remark code N874 is an alert indicating the final payment was set via open negotiation under the No Surprises Act.

Remark code N875 indicates the final payment matches the out-of-network rate set by a Federal Independent Dispute Resolution Entity under the No Surprises Act.

Remark code N876 indicates a service is covered but denied payment under the No Surprises Act, allowing negotiation for a higher out-of-network rate.

Remark code N877 indicates an initial payment under the No Surprises Act, allowing providers to negotiate for a higher out-of-network rate if desired.

Remark code N878 indicates failure to comply with the No Surprises Act for notice and consent, affecting cost sharing and prohibiting balance billing.

Remark code N879 indicates balance billing is not allowed for services due to lack of proper consent under the No Surprises Act.

Remark code N880 indicates an original claim was closed due to data changes, with an adjustment claim to be processed under a new number.

Remark code N881 indicates the patient's financial responsibility for Home & Community Based Services (HCBS) costs not covered by insurance.

Remark code N882 is an alert indicating out-of-network payment amounts were set based on plan allowance after consent to waive balance billing protections.

Remark code N883 indicates a claim has been processed in compliance with specific state legislation.

Remark code N884 is an alert indicating the No Surprises Act may apply to this claim, advising to contact the payer for further instructions.

Remark code N885 is an alert that a claim didn't meet No Surprises Act rules per the payer, suggesting an appeal may be necessary.

Remark code N886 indicates a Health Care Claim Request for Additional Information (277 RFAI) has been issued.

Remark code N887 explains that non-participating providers can appeal Medicare Advantage Plan decisions on payment denials or discrepancies within 60 days, requiring a Waiver of Liability Statement.

Remark code N888 is an alert indicating an electronic request for more information has been sent regarding this claim.

Remark code N889 is an alert indicating a claim was processed in real-time with a real-time 835 response already sent.

Remark code N890 is an alert that Electronic Visit Verification data requirements were not fulfilled in a claim submission.

Remark code N891 indicates the primary insurance has fully covered the service/procedure cost, leaving no additional payment due.

Remark code N892 is an alert that the claim's use of the Delay Reason Code fails to meet required criteria.

Remark code N893 indicates a claim denial due to a missing, incomplete, or invalid child medical evaluation form/checklist.

Remark code N894 is an alert that payments may be recouped based on litigation outcomes, regulatory updates, or other factors affecting the payor's obligations.

Remark code N895 indicates a claim was adjusted according to a negotiated fee schedule for a specialty drug program.