Denial code N40

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

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

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

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

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

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

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

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

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

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

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

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.