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RARC N-Series Remark Codes

All 887 active RARC N-series Remittance Advice Remark Codes and their meanings. RARC codes supplement CARC denial reasons on the EOB/ERA. Search a code or keyword below.

N1
You may appeal this decision in writing within the required time limits following receipt of this notice by following the instructions included in your contract, plan benefit docu…
N2
This allowance has been made in accordance with the most appropriate course of treatment provision of the plan
N3
Missing consent form
N4
Missing/invalid prior Insurance Carrier(s) EOB
N5
EOB received from previous payer. Claim not on file
N6
Under FEHB law), we cannot pay more for covered care than the amount Medicare would have allowed if the patient were enrolled in Medicare Part A and/or Medicare Part B
N7
Processing of this claim/service has included consideration under Major Medical provisions
N8
Crossover claim denied by previous payer and complete claim data not forwarded. Resubmit this claim to this payer to provide adequate data for adjudication
N9
Adjustment represents the estimated amount a previous payer may pay
N10
Adjustment based on the findings of a review organization/professional consult/manual adjudication/medical advisor/dental advisor/peer review
N11
Denial reversed because of medical review
N12
Policy provides coverage supplemental to Medicare. As the member does not appear to be enrolled in the applicable part of Medicare, the member is responsible for payment of the po…
N13
Payment based on professional/technical component modifier(s)
N15
Services for a newborn must be billed separately
N16
Family/member Out-of-Pocket maximum has been met. Payment based on a higher percentage
N19
Procedure code incidental to primary procedure
N20
Service not payable with other service rendered on the same date
N21
Your line item has been separated into multiple lines to expedite handling
N22
This procedure code was added/changed because it more accurately describes the services rendered
N23
Patient liability may be affected due to coordination of benefits with other carriers and/or maximum benefit provisions
N24
Missing/invalid Electronic Funds Transfer banking information
N25
This company has been contracted by your benefit plan to provide administrative claims payment services only. This company does not assume financial risk or obligation with respec…
N26
Missing itemized bill/statement
N27
Missing/invalid treatment number
N28
Consent form requirements not fulfilled
N30
Patient ineligible for this service
N31
Missing/invalid prescribing provider identifier
N32
Claim must be submitted by the provider who rendered the service
N33
No record of health check prior to initiation of treatment
N34
Incorrect claim form/format for this service
N35
Program integrity/utilization review decision
N36
Claim must meet primary payer's processing requirements before we can consider payment
N37
Missing/invalid tooth number/letter
N39
Procedure code is not compatible with tooth number/letter
N40
Missing radiology film(s)/image(s)
N42
Missing mental health assessment
N43
Bed hold or leave days exceeded
N45
Payment based on authorized amount
N46
Missing/invalid admission hour
N47
Claim conflicts with another inpatient stay
N48
Claim information does not agree with information received from other insurance carrier
N49
Court ordered coverage information needs validation
N50
Missing/invalid discharge information
N51
Electronic interchange agreement not on file for provider/submitter
N52
Patient not enrolled in the billing provider's managed care plan on the date of service
N53
Missing/invalid point of pick-up address
N54
Claim information is inconsistent with pre-certified/authorized services
N55
Procedures for billing with group/referring/performing providers were not followed
N56
Procedure code billed is not correct/valid for the services billed or the date of service billed
N57
Missing/invalid prescribing date
N58
Missing/invalid patient liability amount
N59
Please refer to your provider manual for additional program and provider information
N61
Rebill services on separate claims
N62
Dates of service span multiple rate periods. Resubmit separate claims
N63
Rebill services on separate claim lines
N64
The 'from' and 'to' dates must be different
N65
Procedure code or procedure rate count cannot be determined, or was not on file, for the date of service/provider
N67
Professional provider services not paid separately. Included in facility payment under a demonstration project. Apply to that facility for payment, or resubmit your claim if: the…
N68
Prior payment being cancelled as we were subsequently notified this patient was covered by a demonstration project in this site of service. Professional services were included in…
N69
PPS code changed by claims processing system
N70
Consolidated billing and payment applies
N71
Your unassigned claim for a drug or biological, clinical diagnostic laboratory services or ambulance service was processed as an assigned claim. You are required by law to accept…
N72
PPS code changed by medical reviewers. Not supported by clinical records
N74
Resubmit with multiple claims, each claim covering services provided in only one calendar month
N75
Missing/invalid tooth surface information
N76
Missing/invalid number of riders
N77
Missing/invalid designated provider number
N78
The necessary components of the child and teen checkup were not completed
N79
Service billed is not compatible with patient location information
N80
Missing/invalid prenatal screening information
N81
Procedure billed is not compatible with tooth surface code
N82
Provider must accept insurance payment as payment in full when a third party payer contract specifies full reimbursement
N83
No appeal rights. Adjudicative decision based on the provisions of a demonstration project
N84
Further installment payments are forthcoming
N85
This is the final installment payment
N86
A failed trial of pelvic muscle exercise training is required in order for biofeedback training for the treatment of urinary incontinence to be covered
N87
Home use of biofeedback therapy is not covered
N88
This payment is being made conditionally. An HHA episode of care notice has been filed for this patient. When a patient is treated under a HHA episode of care, consolidated billin…
N89
Payment information for this claim has been forwarded to more than one other payer, but format limitations permit only one of the secondary payers to be identified in this remitta…
N90
Covered only when performed by the attending physician
N91
Services not included in the appeal review
N92
This facility is not certified for digital mammography
N93
A separate claim must be submitted for each place of service. Services furnished at multiple sites may not be billed in the same claim
N94
Claim/Service denied because a more specific taxonomy code is required for adjudication
N95
This provider type/provider specialty may not bill this service
N96
Patient must be refractory to conventional therapy and be an appropriate surgical candidate such that implantation with anesthesia can occur
N97
Patients with stress incontinence, urinary obstruction, and specific neurologic diseases which are associated with secondary manifestations of the above three indications are excl…
N98
Patient must have had a successful test stimulation in order to support subsequent implantation. Before a patient is eligible for permanent implantation, he/she must demonstrate a…
N99
Patient must be able to demonstrate adequate ability to record voiding diary data such that clinical results of the implant procedure can be properly evaluated
N103
Records indicate this patient was a prisoner or in custody of a Federal, State, or local authority when the service was rendered. This payer does not cover items and services furn…
N104
This claim/service is not payable under our claims jurisdiction area. You can identify the correct Medicare contractor to process this claim/service through the CMS website at www…
N105
This is a misdirected claim/service for an RRB beneficiary. Submit paper claims to the RRB carrier: Palmetto GBA, P.O. Box 10066, Augusta, GA 30999. Call 888-355-9165 for RRB EDI…
N106
Payment for services furnished to Skilled Nursing Facility inpatients can only be made to the SNF. You must request payment from the SNF rather than the patient for this service
N107
Services furnished to Skilled Nursing Facility inpatients must be billed on the inpatient claim. They cannot be billed separately as outpatient services
N108
Missing/invalid upgrade information
N109
This claim/service was chosen for complex review
N110
This facility is not certified for film mammography
N111
No appeal right except duplicate claim/service issue. This service was included in a claim that has been previously billed and adjudicated
N112
This claim is excluded from your electronic remittance advice
N113
Only one initial visit is covered per physician, group practice or provider
N114
During the transition to the Ambulance Fee Schedule, payment is based on the lesser of a blended amount calculated using a percentage of the reasonable charge/cost and fee schedul…
N115
This decision was based on a Local Coverage Determination. An LCD provides a guide to assist in determining whether a particular item or service is covered. A copy of this policy…
N116
This payment is being made conditionally because the service was provided in the home, and it is possible that the patient is under a home health episode of care. When a patient i…
N117
This service is paid only once in a patient's lifetime
N118
This service is not paid if billed more than once every 28 days
N119
This service is not paid if billed once every 28 days, and the patient has spent 5 or more consecutive days in any inpatient or Skilled /nursing Facility within those 28 days
N120
Payment is subject to home health prospective payment system partial episode payment adjustment. Patient was transferred/discharged/readmitted during payment episode
N121
Medicare Part B does not pay for items or services provided by this type of practitioner for beneficiaries in a Medicare Part A covered Skilled Nursing Facility stay
N122
Add-on code cannot be billed by itself
N123
This is a split service and represents a portion of the units from the originally submitted service
N124
Payment has been denied for the/made only for a less extensive service/item because the information furnished does not substantiate the need for the service/item. The patient is l…
N125
Payment has been service/item because the information furnished does not substantiate the need for the service/item. If you have collected any amount from the patient, you must re…
N126
Social Security Records indicate that this individual has been deported. This payer does not cover items and services furnished to individuals who have been deported
N127
This is a misdirected claim/service for a United Mine Workers of America beneficiary. Please submit claims to them
N128
This amount represents the prior to coverage portion of the allowance
N129
Not eligible due to the patient's age
N130
Consult plan benefit documents/guidelines for information about restrictions for this service
N131
Total payments under multiple contracts cannot exceed the allowance for this service
N132
Payments will cease for services rendered by this US Government debarred or excluded provider after the 30 day grace period as previously notified
N133
Services for predetermination and services requesting payment are being processed separately
N134
This represents your scheduled payment for this service. If treatment has been discontinued, please contact Customer Service
N135
Record fees are the patient's responsibility and limited to the specified co-payment
N136
To obtain information on the process to file an appeal in Arizona, call the Department's Consumer Assistance Office at 912-8444 or 325-2548
N137
The provider acting on the Member's behalf, may file an appeal with the Payer. The provider, acting on the Member's behalf, may file a complaint with the State Insurance Regulator…
N138
In the event you disagree with the Dental Advisor's opinion and have additional information relative to the case, you may submit radiographs to the Dental Advisor Unit at the subs…
N139
Under 32 CFR 199.13, a non-participating provider is not an appropriate appealing party. Therefore, if you disagree with the Dental Advisor's opinion, you may appeal the determina…
N140
You have not been designated as an authorized OCONUS provider therefore are not considered an appropriate appealing party. If the beneficiary has appointed you, in writing, to act…
N141
The patient was not residing in a long-term care facility during all or part of the service dates billed
N142
The original claim was denied. Resubmit a new claim, not a replacement claim
N143
The patient was not in a hospice program during all or part of the service dates billed
N144
The rate changed during the dates of service billed
N146
Missing screening document
N147
Long term care case mix or per diem rate cannot be determined because the patient ID number is missing, incomplete, or invalid on the assignment request
N148
Missing/invalid date of last menstrual period
N149
Rebill all applicable services on a single claim
N150
Missing/invalid model number
N151
Telephone contact services will not be paid until the face-to-face contact requirement has been met
N152
Missing/invalid replacement claim information
N153
Missing/invalid room and board rate
N154
This payment was delayed for correction of provider's mailing address
N155
Our records do not indicate that other insurance is on file. Please submit other insurance information for our records
N156
The patient is responsible for the difference between the approved treatment and the elective treatment
N157
Transportation to/from this destination is not covered
N158
Transportation in a vehicle other than an ambulance is not covered
N159
Payment denied/reduced because mileage is not covered when the patient is not in the ambulance
N160
The patient must choose an option before a payment can be made for this procedure/ equipment/ supply/ service
N161
This drug/service/supply is covered only when the associated service is covered
N162
Although your claim was paid, you have billed for a test/specialty not included in your Laboratory Certification. Your failure to correct the laboratory certification information…
N163
Medical record does not support code billed per the code definition
N167
Charges exceed the post-transplant coverage limit
N170
A new/revised/renewed certificate of medical necessity is needed
N171
Payment for repair or replacement is not covered or has exceeded the purchase price
N172
The patient is not liable for the denied/adjusted charge(s) for receiving any updated service/item
N173
No qualifying hospital stay dates were provided for this episode of care
N174
This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'
N175
Missing review organization approval
N176
Services provided aboard a ship are covered only when the ship is of United States registry and is in United States waters. In addition, a doctor licensed to practice in the Unite…
N177
We did not send this claim to patient's other insurer. They have indicated no additional payment can be made
N178
Missing pre-operative images/visual field results
N179
Additional information has been requested from the member. The charges will be reconsidered upon receipt of that information
N180
This item or service does not meet the criteria for the category under which it was billed
N181
Additional information is required from another provider involved in this service
N182
This claim/service must be billed according to the schedule for this plan
N183
This is a predetermination advisory message, when this service is submitted for payment additional documentation as specified in plan documents will be required to process benefits
N184
Rebill technical and professional components separately
N185
Do not resubmit this claim/service
N186
Non-Availability Statement required for this service. Contact the nearest Military Treatment Facility for assistance
N187
You may request a review in writing within the required time limits following receipt of this notice by following the instructions included in your contract or plan benefit docume…
N188
The approved level of care does not match the procedure code submitted
N189
This service has been paid as a one-time exception to the plan's benefit restrictions
N190
Missing contract indicator
N191
The provider must update insurance information directly with payer
N192
Patient is a Medicaid/Qualified Medicare Beneficiary
N193
Specific federal/state/local program may cover this service through another payer
N194
Technical component not paid if provider does not own the equipment used
N195
The technical component must be billed separately
N196
Patient eligible to apply for other coverage which may be primary
N197
The subscriber must update insurance information directly with payer
N198
Rendering provider must be affiliated with the pay-to provider
N199
Additional payment/recoupment approved based on payer-initiated review/audit
N200
The professional component must be billed separately
N202
Additional information/explanation will be sent separately
N203
Missing/invalid anesthesia time/units
N204
Services under review for possible pre-existing condition. Send medical records for prior 12 months
N205
Information provided was illegible
N206
The supporting documentation does not match the information sent on the claim
N207
Missing/invalid weight
N208
Missing/invalid DRG code
N209
Missing/invalid taxpayer identification number
N210
You may appeal this decision
N211
You may not appeal this decision
N212
Charges processed under a Point of Service benefit
N213
Missing/invalid facility/discrete unit DRG/DRG exempt status information
N214
Missing/invalid history of the related initial surgical procedure(s)
N215
A payer providing supplemental or secondary coverage shall not require a claims determination for this service from a primary payer as a condition of making its own claims determi…
N216
We do not offer coverage for this type of service or the patient is not enrolled in this portion of our benefit package
N217
We pay only one site of service per provider per claim
N218
You must furnish and service this item for as long as the patient continues to need it. We can pay for maintenance and/or servicing for the time period specified in the contract o…
N219
Payment based on previous payer's allowed amount
N220
See the payer's web site or contact the payer's Customer Service department to obtain forms and instructions for filing a provider dispute
N221
Missing Admitting History and Physical report
N222
Incomplete/invalid Admitting History and Physical report
N223
Missing documentation of benefit to the patient during initial treatment period
N224
Incomplete/invalid documentation of benefit to the patient during initial treatment period
N226
Incomplete/invalid American Diabetes Association Certificate of Recognition
N227
Incomplete/invalid Certificate of Medical Necessity
N228
Incomplete/invalid consent form
N229
Incomplete/invalid contract indicator
N230
Incomplete/invalid indication of whether the patient owns the equipment that requires the part or supply
N231
Incomplete/invalid invoice or statement certifying the actual cost of the lens, less discounts, and/or the type of intraocular lens used
N232
Incomplete/invalid itemized bill/statement
N233
Incomplete/invalid operative note/report
N234
Incomplete/invalid oxygen certification/re-certification
N235
Incomplete/invalid pacemaker registration form
N236
Incomplete/invalid pathology report
N237
Incomplete/invalid patient medical record for this service
N238
Incomplete/invalid physician certified plan of care
N239
Incomplete/invalid physician financial relationship form
N240
Incomplete/invalid radiology report
N241
Incomplete/invalid review organization approval
N242
Incomplete/invalid radiology film(s)/image(s)
N243
Incomplete/invalid/not approved screening document
N244
Incomplete/Invalid pre-operative images/visual field results
N245
Incomplete/invalid plan information for other insurance
N246
State regulated patient payment limitations apply to this service
N247
Missing/invalid assistant surgeon taxonomy
N248
Missing/invalid assistant surgeon name
N249
Missing/invalid assistant surgeon primary identifier
N250
Missing/invalid assistant surgeon secondary identifier
N251
Missing/invalid attending provider taxonomy
N252
Missing/invalid attending provider name
N253
Missing/invalid attending provider primary identifier
N254
Missing/invalid attending provider secondary identifier
N255
Missing/invalid billing provider taxonomy
N256
Missing/invalid billing provider/supplier name
N257
Missing/invalid billing provider/supplier primary identifier
N258
Missing/invalid billing provider/supplier address
N259
Missing/invalid billing provider/supplier secondary identifier
N260
Missing/invalid billing provider/supplier contact information
N261
Missing/invalid operating provider name
N262
Missing/invalid operating provider primary identifier
N263
Missing/invalid operating provider secondary identifier
N264
Missing/invalid ordering provider name
N265
Missing/invalid ordering provider primary identifier
N266
Missing/invalid ordering provider address
N267
Missing/invalid ordering provider secondary identifier
N268
Missing/invalid ordering provider contact information
N269
Missing/invalid other provider name
N270
Missing/invalid other provider primary identifier
N271
Missing/invalid other provider secondary identifier
N272
Missing/invalid other payer attending provider identifier
N273
Missing/invalid other payer operating provider identifier
N274
Missing/invalid other payer other provider identifier
N275
Missing/invalid other payer purchased service provider identifier
N276
Missing/invalid other payer referring provider identifier
N277
Missing/invalid other payer rendering provider identifier
N278
Missing/invalid other payer service facility provider identifier
N279
Missing/invalid pay-to provider name
N280
Missing/invalid pay-to provider primary identifier
N281
Missing/invalid pay-to provider address
N282
Missing/invalid pay-to provider secondary identifier
N283
Missing/invalid purchased service provider identifier
N284
Missing/invalid referring provider taxonomy
N285
Missing/invalid referring provider name
N286
Missing/invalid referring provider primary identifier
N287
Missing/invalid referring provider secondary identifier
N288
Missing/invalid rendering provider taxonomy
N289
Missing/invalid rendering provider name
N290
Missing/invalid rendering provider primary identifier
N291
Missing/invalid rendering provider secondary identifier
N292
Missing/invalid service facility name
N293
Missing/invalid service facility primary identifier
N294
Missing/invalid service facility primary address
N295
Missing/invalid service facility secondary identifier
N296
Missing/invalid supervising provider name
N297
Missing/invalid supervising provider primary identifier
N298
Missing/invalid supervising provider secondary identifier
N299
Missing/invalid occurrence date(s)
N300
Missing/invalid occurrence span date(s)
N301
Missing/invalid procedure date(s)
N302
Missing/invalid other procedure date(s)
N303
Missing/invalid principal procedure date
N304
Missing/invalid dispensed date
N305
Missing/invalid injury/accident date
N306
Missing/invalid acute manifestation date
N307
Missing/invalid adjudication or payment date
N308
Missing/invalid appliance placement date
N309
Missing/invalid assessment date
N310
Missing/invalid assumed or relinquished care date
N311
Missing/invalid authorized to return to work date
N312
Missing/invalid begin therapy date
N313
Missing/invalid certification revision date
N314
Missing/invalid diagnosis date
N315
Missing/invalid disability from date
N316
Missing/invalid disability to date
N317
Missing/invalid discharge hour
N318
Missing/invalid discharge or end of care date
N319
Missing/invalid hearing or vision prescription date
N320
Missing/invalid Home Health Certification Period
N321
Missing/invalid last admission period
N322
Missing/invalid last certification date
N323
Missing/invalid last contact date
N324
Missing/invalid last seen/visit date
N325
Missing/invalid last worked date
N326
Missing/invalid last x-ray date
N327
Missing/invalid other insured birth date
N328
Missing/invalid Oxygen Saturation Test date
N329
Missing/invalid patient birth date
N330
Missing/invalid patient death date
N331
Missing/invalid physician order date
N332
Missing/invalid prior hospital discharge date
N333
Missing/invalid prior placement date
N334
Missing/invalid re-evaluation date
N335
Missing/invalid referral date
N336
Missing/invalid replacement date
N337
Missing/invalid secondary diagnosis date
N338
Missing/invalid shipped date
N339
Missing/invalid similar illness or symptom date
N340
Missing/invalid subscriber birth date
N341
Missing/invalid surgery date
N342
Missing/invalid test performed date
N343
Missing/invalid Transcutaneous Electrical Nerve Stimulator trial start date
N344
Missing/invalid Transcutaneous Electrical Nerve Stimulator trial end date
N345
Date range not valid with units submitted
N346
Missing/invalid oral cavity designation code
N347
Your claim for a referred or purchased service cannot be paid because payment has already been made for this same service to another provider by a payment contractor representing…
N348
You chose that this service/supply/drug would be rendered/supplied and billed by a different practitioner/supplier
N349
The administration method and drug must be reported to adjudicate this service
N350
Missing/invalid description of service for a Not Otherwise Classified code or for an Unlisted/By Report procedure
N351
Service date outside of the approved treatment plan service dates
N352
There are no scheduled payments for this service. Submit a claim for each patient visit
N353
Benefits have been estimated, when the actual services have been rendered, additional payment will be considered based on the submitted claim
N354
Incomplete/invalid invoice
N355
The law permits exceptions to the refund requirement in two cases: - If you did not know, and could not have reasonably been expected to know, that we would not pay for this servi…
N356
Not covered when performed with, or subsequent to, a non-covered service
N357
Time frame requirements between this service/procedure/supply and a related service/procedure/supply have not been met
N358
This decision may be reviewed if additional documentation as described in the contract or plan benefit documents is submitted
N359
Missing/invalid height
N360
Coordination of benefits has not been calculated when estimating benefits for this pre-determination. Submit payment information from the primary payer with the secondary claim
N362
The number of Days or Units of Service exceeds our acceptable maximum
N363
in the near future we are implementing new policies/procedures that would affect this determination
N364
According to our agreement, you must waive the deductible and/or coinsurance amounts
N366
Requested information not provided. The claim will be reopened if the information previously requested is submitted within one year after the date of this denial notice
N367
The claim information has been forwarded to a Consumer Spending Account processor for review; for example, flexible spending account or health savings account
N368
You must appeal the determination of the previously adjudicated claim
N369
Although this claim has been processed, it is deficient according to state legislation/regulation
N370
Billing exceeds the rental months covered/approved by the payer
N371
title of this equipment must be transferred to the patient
N372
Only reasonable and necessary maintenance/service charges are covered
N373
It has been determined that another payer paid the services as primary when they were not the primary payer. Therefore, we are refunding to the payer that paid as primary on your…
N374
Primary Medicare Part A insurance has been exhausted and a Part B Remittance Advice is required
N375
Missing/invalid questionnaire/information required to determine dependent eligibility
N376
Subscriber/patient is assigned to active military duty, therefore primary coverage may be TRICARE
N377
Payment based on a processed replacement claim
N378
Missing/invalid prescription quantity
N379
Claim level information does not match line level information
N380
The original claim has been processed, submit a corrected claim
N381
Consult our contractual agreement for restrictions/billing/payment information related to these charges
N382
Missing/invalid patient identifier
N383
Not covered when deemed cosmetic
N384
Records indicate that the referenced body part/tooth has been removed in a previous procedure
N385
Notification of admission was not timely according to published plan procedures
N386
This decision was based on a National Coverage Determination. An NCD provides a coverage determination as to whether a particular item or service is covered. Visit CMS.gov and sea…
N387
Submit this claim to the patient's other insurer for potential payment of supplemental benefits. We did not forward the claim information
N388
Missing/invalid prescription number
N389
Duplicate prescription number submitted
N390
This service/report cannot be billed separately
N391
Missing emergency department records
N392
Incomplete/invalid emergency department records
N393
Missing progress notes/report
N394
Incomplete/invalid progress notes/report
N395
Missing laboratory report
N396
Incomplete/invalid laboratory report
N397
Benefits are not available for incomplete service(s)/undelivered item(s)
N398
Missing elective consent form
N399
Incomplete/invalid elective consent form
N400
Electronically enabled providers should submit claims electronically
N401
Missing periodontal charting
N402
Incomplete/invalid periodontal charting
N403
Missing facility certification
N404
Incomplete/invalid facility certification
N405
This service is only covered when the donor's insurer(s) do not provide coverage for the service
N406
This service is only covered when the recipient's insurer(s) do not provide coverage for the service
N407
You are not an approved submitter for this transmission format
N408
This payer does not cover deductibles assessed by a previous payer
N409
This service is related to an accidental injury and is not covered unless provided within a specific time frame from the date of the accident
N410
Not covered unless the prescription changes
N411
This service is allowed one time in a 6-month period
N412
This service is allowed 2 times in a 12-month period
N413
This service is allowed 2 times in a benefit year
N414
This service is allowed 4 times in a 12-month period
N415
This service is allowed 1 time in an 18-month period
N416
This service is allowed 1 time in a 3-year period
N417
This service is allowed 1 time in a 5-year period
N418
Misrouted claim. See the payer's claim submission instructions
N419
Claim payment was the result of a payer's retroactive adjustment due to a retroactive rate change
N420
Claim payment was the result of a payer's retroactive adjustment due to a Coordination of Benefits or Third Party Liability Recovery
N421
Claim payment was the result of a payer's retroactive adjustment due to a review organization decision
N422
Claim payment was the result of a payer's retroactive adjustment due to a payer's contract incentive program
N423
Claim payment was the result of a payer's retroactive adjustment due to a non standard program
N424
Patient does not reside in the geographic area required for this type of payment
N425
Statutorily excluded service(s)
N426
No coverage when self-administered
N427
Payment for eyeglasses or contact lenses can be made only after cataract surgery
N428
Not covered when performed in this place of service
N429
Not covered when considered routine
N430
Procedure code is inconsistent with the units billed
N431
Not covered with this procedure
N432
Adjustment based on a Recovery Audit
N433
Resubmit this claim using only your NPI
N434
Missing/invalid Present on Admission indicator
N435
Exceeds number/frequency approved /allowed within time period without support documentation
N436
The injury claim has not been accepted and a mandatory medical reimbursement has been made
N437
If the injury claim is accepted, these charges will be reconsidered
N438
This jurisdiction only accepts paper claims
N439
Missing anesthesia physical status report/indicators
N440
Incomplete/invalid anesthesia physical status report/indicators
N441
This missed/cancelled appointment is not covered
N442
Payment based on an alternate fee schedule
N443
Missing/invalid total time or begin/end time
N444
This facility has not filed the Election for High Cost Outlier form with the Division of Workers' Compensation
N445
Missing document for actual cost or paid amount
N446
Incomplete/invalid document for actual cost or paid amount
N447
Payment is based on a generic equivalent as required documentation was not provided
N448
This drug/service/supply is not included in the fee schedule or contracted/legislated fee arrangement
N449
Payment based on a comparable drug/service/supply
N450
Covered only when performed by the primary treating physician or the designee
N451
Missing Admission Summary Report
N452
Incomplete/invalid Admission Summary Report
N453
Missing Consultation Report
N454
Incomplete/invalid Consultation Report
N455
Missing Physician Order
N456
Incomplete/invalid Physician Order
N457
Missing Diagnostic Report
N458
Incomplete/invalid Diagnostic Report
N459
Missing Discharge Summary
N460
Incomplete/invalid Discharge Summary
N461
Missing Nursing Notes
N462
Incomplete/invalid Nursing Notes
N463
Missing support data for claim
N464
Incomplete/invalid support data for claim
N465
Missing Physical Therapy Notes/Report
N466
Incomplete/invalid Physical Therapy Notes/Report
N467
Missing Tests and Analysis Report
N468
Incomplete/invalid Report of Tests and Analysis Report
N469
Claim/Service(s) subject to appeal process, see section 935 of Medicare Prescription Drug, Improvement, and Modernization Act of 2003
N470
This payment will complete the mandatory medical reimbursement limit
N471
Missing/invalid HIPPS Rate Code
N472
Payment for this service has been issued to another provider
N473
Missing certification
N474
Incomplete/invalid certification
N475
Missing completed referral form
N476
Incomplete/invalid completed referral form
N477
Missing Dental Models
N478
Incomplete/invalid Dental Models
N479
Missing Explanation of Benefits
N480
Incomplete/invalid Explanation of Benefits
N481
Missing Models
N482
Incomplete/invalid Models
N485
Missing Physical Therapy Certification
N486
Incomplete/invalid Physical Therapy Certification
N487
Missing Prosthetics or Orthotics Certification
N488
Incomplete/invalid Prosthetics or Orthotics Certification
N489
Missing referral form
N490
Incomplete/invalid referral form
N491
Missing/invalid Exclusionary Rider Condition
N492
A network provider may bill the member for this service if the member requested the service and agreed in writing, prior to receiving the service, to be financially responsible fo…
N493
Missing Doctor First Report of Injury
N494
Incomplete/invalid Doctor First Report of Injury
N495
Missing Supplemental Medical Report
N496
Incomplete/invalid Supplemental Medical Report
N497
Missing Medical Permanent Impairment or Disability Report
N498
Incomplete/invalid Medical Permanent Impairment or Disability Report
N499
Missing Medical Legal Report
N500
Incomplete/invalid Medical Legal Report
N501
Missing Vocational Report
N502
Incomplete/invalid Vocational Report
N503
Missing Work Status Report
N504
Incomplete/invalid Work Status Report
N505
This response includes only services that could be estimated in real-time. No estimate will be provided for the services that could not be estimated in real-time
N506
This is an estimate of the member's liability based on the information available at the time the estimate was processed. Actual coverage and member liability amounts will be deter…
N507
Plan distance requirements have not been met
N508
This real-time claim adjudication response represents the member responsibility to the provider for services reported. The member will receive an Explanation of Benefits electroni…
N509
A current inquiry shows the member's Consumer Spending Account contains sufficient funds to cover the member liability for this claim/service. Actual payment from the Consumer Spe…
N510
A current inquiry shows the member's Consumer Spending Account does not contain sufficient funds to cover the member's liability for this claim/service. Actual payment from the Co…
N511
Information on the availability of Consumer Spending Account funds to cover the member liability on this claim/service is not available at this time
N512
This is the initial remit of a non-NCPDP claim originally submitted real-time without change to the adjudication
N513
This is the initial remit of a non-NCPDP claim originally submitted real-time with a change to the adjudication
N516
Records indicate a mismatch between the submitted NPI and EIN
N517
Resubmit a new claim with the requested information
N518
No separate payment for accessories when furnished for use with oxygen equipment
N519
Invalid combination of HCPCS modifiers
N520
Payment made from a Consumer Spending Account
N521
Mismatch between the submitted provider information and the provider information stored in our system
N522
Duplicate of a claim processed, or to be processed, as a crossover claim
N523
The limitation on outlier payments defined by this payer for this service period has been met. The outlier payment otherwise applicable to this claim has not been paid
N524
Based on policy this payment constitutes payment in full
N525
These services are not covered when performed within the global period of another service
N526
Not qualified for recovery based on employer size
N527
We processed this claim as the primary payer prior to receiving the recovery demand
N528
Patient is entitled to benefits for Institutional Services only
N529
Patient is entitled to benefits for Professional Services only
N530
Not Qualified for Recovery based on enrollment information
N531
Not qualified for recovery based on direct payment of premium
N532
Not qualified for recovery based on disability and working status
N533
Services performed in an Indian Health Services facility under a self-insured tribal Group Health Plan
N534
This is an individual policy, the employer does not participate in plan sponsorship
N535
Payment is adjusted when procedure is performed in this place of service based on the submitted procedure code and place of service
N536
We are not changing the prior payer's determination of patient responsibility, which you may collect, as this service is not covered by us
N537
We have examined claims history and no records of the services have been found
N538
A facility is responsible for payment to outside providers who furnish these services/supplies/drugs to its patients/residents
N539
We processed appeals/waiver requests on your behalf and that request has been denied
N540
Payment adjusted based on the interrupted stay policy
N541
Mismatch between the submitted insurance type code and the information stored in our system
N542
Missing income verification
N543
Incomplete/invalid income verification
N544
Although this was paid, you have billed with a referring/ordering provider that does not match our system record. Unless corrected this will not be paid in the future
N545
Payment reduced based on status as an unsuccessful eprescriber per the Electronic Prescribing Incentive Program
N546
Payment represents a previous reduction based on the Electronic Prescribing Incentive Program
N547
A refund request was processed previously
N548
Patient's calendar year deductible has been met
N549
Patient's calendar year out-of-pocket maximum has been met
N550
You have not responded to requests to revalidate your provider/supplier enrollment information. Your failure to revalidate your enrollment information will result in a payment hol…
N551
Payment adjusted based on the Ambulatory Surgical Center Quality Reporting Program
N552
Payment adjusted to reverse a previous withhold/bonus amount
N554
Missing/invalid Family Planning Indicator
N555
Missing medication list
N556
Incomplete/invalid medication list
N557
This claim/service is not payable under our service area. The claim must be filed to the Payer/Plan in whose service area the specimen was collected
N558
This claim/service is not payable under our service area. The claim must be filed to the Payer/Plan in whose service area the equipment was received
N559
This claim/service is not payable under our service area. The claim must be filed to the Payer/Plan in whose service area the Ordering Physician is located
N560
The pilot program requires an interim or final claim within 60 days of the Notice of Admission. A claim was not received
N561
The bundled claim originally submitted for this episode of care includes related readmissions. You may resubmit the original claim to receive a corrected payment based on this rea…
N562
The provider number of your incoming claim does not match the provider number on the processed Notice of Admission for this bundled payment
N563
Missing required provider/supplier issuance of advance patient notice of non-coverage. The patient is not liable for payment for this service
N564
Patient did not meet the inclusion criteria for the demonstration project or pilot program
N565
This non-payable reporting code requires a modifier. Future claims containing this non-payable reporting code must include an appropriate modifier for the claim to be processed
N566
This procedure code requires functional reporting. Future claims containing this procedure code must include an applicable non-payable code and appropriate modifiers for the claim…
N567
Not covered when considered preventative
N568
Initial payment based on the Notice of Admission under the Bundled Payment Model IV initiative
N569
Not covered when performed for the reported diagnosis
N570
Missing/invalid credentialing data
N571
Payment will be issued quarterly by another payer/contractor
N572
This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted
N573
You have been overpaid and must refund the overpayment. The refund will be requested separately by another payer/contractor
N574
Our records indicate the ordering/referring provider is of a type/specialty that cannot order or refer. Please verify that the claim ordering/referring provider information is acc…
N575
Mismatch between the submitted ordering/referring provider name and the ordering/referring provider name stored in our records
N576
Services not related to the specific incident/claim/accident/loss being reported
N577
Personal Injury Protection Coverage
N578
Coverages do not apply to this loss
N579
Medical Payments Coverage
N580
Determination based on the provisions of the insurance policy
N581
Investigation of coverage eligibility is pending
N582
Benefits suspended pending the patient's cooperation
N583
Patient was not an occupant of our insured vehicle and therefore, is not an eligible injured person
N584
Not covered based on the insured's noncompliance with policy or statutory conditions
N585
Benefits are no longer available based on a final injury settlement
N586
The injured party does not qualify for benefits
N587
Policy benefits have been exhausted
N588
The patient has instructed that medical claims/bills are not to be paid
N589
Coverage is excluded to any person injured as a result of operating a motor vehicle while in an intoxicated condition or while the ability to operate such a vehicle is impaired by…
N590
Missing independent medical exam detailing the cause of injuries sustained and medical necessity of services rendered
N591
Payment based on an Independent Medical Examination or Utilization Review
N592
Adjusted because this is not the initial prescription or exceeds the amount allowed for the initial prescription
N593
Not covered based on failure to attend a scheduled Independent Medical Exam
N594
Records reflect the injured party did not complete an Application for Benefits for this loss
N595
Records reflect the injured party did not complete an Assignment of Benefits for this loss
N596
Records reflect the injured party did not complete a Medical Authorization for this loss
N597
Adjusted based on a medical/dental provider's apportionment of care between related injuries and other unrelated medical/dental conditions/injuries
N598
Health care policy coverage is primary
N599
Our payment for this service is based upon a reasonable amount pursuant to both the terms and conditions of the policy of insurance under which the subject claim is being made as…
N600
Adjusted based on the applicable fee schedule for the region in which the service was rendered
N601
In accordance with Hawaii Administrative Rules, Title 16, Chapter 23 Motor Vehicle Insurance Law payment is recommended based on Medicare Resource Based Relative Value Scale Syste…
N602
Adjusted based on the Redbook maximum allowance
N603
This fee is calculated according to the New Jersey medical fee schedules for Automobile Personal Injury Protection and Motor Bus Medical Expense Insurance Coverage
N604
In accordance with New York No-Fault Law, Regulation 68, this base fee was calculated according to the New York Workers' Compensation Board Schedule of Medical Fees, pursuant to R…
N605
This fee was calculated based upon New York All Patients Refined Diagnosis Related Groups, pursuant to Regulation 68
N606
The Oregon allowed amount for this procedure is based upon the Workers Compensation Fee Schedule. The allowed amount has been calculated in accordance with Section 4 of ORS 742.524
N607
Service provided for non-compensable condition(s)
N608
The fee schedule amount allowed is calculated at 110% of the Medicare Fee Schedule for this region, specialty and type of service. This fee is calculated in compliance with Act 6
N609
80% of the provider's billed amount is being recommended for payment according to Act 6
N610
Payment based on an appropriate level of care
N611
Claim in litigation. Contact insurer for more information
N612
Medical provider not authorized/certified to provide treatment to injured workers in this jurisdiction
N613
Although this was paid, you have billed with an ordering provider that needs to update their enrollment record. Please verify that the ordering provider information you submitted…
N614
Additional information is included in the 835
N615
This enrollee receiving advance payments of the premium tax credit is in the grace period of three consecutive months for non-payment of premium. Under 45 CFR 156.270, a Qualified…
N616
This enrollee is in the first month of the advance premium tax credit grace period
N617
This enrollee is in the second or third month of the advance premium tax credit grace period
N618
This claim will automatically be reprocessed if the enrollee pays their premiums
N619
Coverage terminated for non-payment of premium
N620
This procedure code is for quality reporting/informational purposes only
N621
Charges for Jurisdiction required forms, reports, or chart notes are not payable
N622
Not covered based on the date of injury/accident
N623
Not covered when deemed unscientific/unproven/outmoded/experimental/excessive/inappropriate
N624
The associated Workers' Compensation claim has been withdrawn
N625
Missing/invalid Workers' Compensation Claim Number
N626
New or established patient E/M codes are not payable with chiropractic care codes
N628
Out-patient follow up visits on the same date of service as a scheduled test or treatment is disallowed
N629
Reviews/documentation/notes/summaries/reports/charts not requested
N630
Referral not authorized by attending physician
N631
Medical Fee Schedule does not list this code. An allowance was made for a comparable service
N633
Additional anesthesia time units are not allowed
N634
The allowance is calculated based on anesthesia time units
N635
The Allowance is calculated based on the anesthesia base units plus time
N636
Adjusted because this is reimbursable only once per injury
N637
Consultations are not allowed once treatment has been rendered by the same provider
N638
Reimbursement has been made according to the home health fee schedule
N639
Reimbursement has been made according to the inpatient rehabilitation facilities fee schedule
N640
Exceeds number/frequency approved/allowed within time period
N641
Reimbursement has been based on the number of body areas rated
N642
Adjusted when billed as individual tests instead of as a panel
N643
The services billed are considered Not Covered or Non-Covered in the applicable state fee schedule
N644
Reimbursement has been made according to the bilateral procedure rule
N645
Mark-up allowance
N646
Reimbursement has been adjusted based on the guidelines for an assistant
N647
Adjusted based on diagnosis-related group
N648
Adjusted based on Stop Loss
N649
Payment based on invoice
N650
This policy was not in effect for this date of loss. No coverage is available
N651
No Personal Injury Protection/Medical Payments Coverage on the policy at the time of the loss
N652
The date of service is before the date of loss
N653
The date of injury does not match the reported date of loss
N654
Adjusted based on achievement of maximum medical improvement
N655
Payment based on provider's geographic region
N656
An interest payment is being made because benefits are being paid outside the statutory requirement
N657
This should be billed with the appropriate code for these services
N658
The billed service(s) are not considered medical expenses
N659
This item is exempt from sales tax
N660
Sales tax has been included in the reimbursement
N661
Documentation does not support that the services rendered were medically necessary
N662
Consideration of payment will be made upon receipt of a final bill
N663
Adjusted based on an agreed amount
N664
Adjusted based on a legal settlement
N665
Services by an unlicensed provider are not reimbursable
N666
Only one evaluation and management code at this service level is covered during the course of care
N667
Missing prescription
N668
Incomplete/invalid prescription
N669
Adjusted based on the Medicare fee schedule
N670
This service code has been identified as the primary procedure code subject to the Medicare Multiple Procedure Payment Reduction rule
N671
Payment based on a jurisdiction cost-charge ratio
N672
Amount applied to Health Insurance Offset
N673
Reimbursement has been calculated based on an outpatient per diem or an outpatient factor and/or fee schedule amount
N674
Not covered unless a pre-requisite procedure/service has been provided
N675
Additional information is required from the injured party
N676
Service does not qualify for payment under the Outpatient Facility Fee Schedule
N677
Films/Images will not be returned
N678
Missing post-operative images/visual field results
N679
Incomplete/Invalid post-operative images/visual field results
N680
Missing/invalid date of previous dental extractions
N681
Missing/invalid full arch series
N682
Missing/invalid history of prior periodontal therapy/maintenance
N683
Missing/invalid prior treatment documentation
N684
Payment denied as this is a specialty claim submitted as a general claim
N685
Missing/invalid Prosthesis, Crown or Inlay Code
N686
Missing/invalid questionnaire needed to complete payment determination
N687
This reversal is due to a retroactive disenrollment
N688
This reversal is due to a medical or utilization review decision
N689
This reversal is due to a retroactive rate change
N690
This reversal is due to a provider submitted appeal
N691
This reversal is due to a patient submitted appeal
N692
This reversal is due to an incorrect rate on the initial adjudication
N693
This reversal is due to a cancellation of the claim by the provider
N694
This reversal is due to a resubmission/change to the claim by the provider
N695
This reversal is due to incorrect patient financial responsibility information on the initial adjudication
N696
This reversal is due to a Coordination of Benefits or Third Party Liability Recovery retroactive adjustment
N697
This reversal is due to a payer's retroactive contract incentive program adjustment
N698
This reversal is due to non-payment of the health insurance premiums by the end of the premium payment grace period, resulting in loss of coverage
N699
Payment adjusted based on the Physician Quality Reporting System Incentive Program
N700
Payment adjusted based on the Electronic Health Records Incentive Program
N701
Payment adjusted based on the Value-based Payment Modifier
N702
Decision based on review of previously adjudicated claims or for claims in process for the same/similar type of services
N703
This service is incompatible with previously adjudicated claims or claims in process
N704
You may not appeal this decision but can resubmit this claim/service with corrected information if warranted
N705
Incomplete/invalid documentation
N706
Missing documentation
N707
Incomplete/invalid orders
N708
Missing orders
N709
Incomplete/invalid notes
N710
Missing notes
N711
Incomplete/invalid summary
N712
Missing summary
N713
Incomplete/invalid report
N714
Missing report
N715
Incomplete/invalid chart
N716
Missing chart
N717
Incomplete/Invalid documentation of face-to-face examination
N718
Missing documentation of face-to-face examination
N719
Penalty applied based on plan requirements not being met
N720
The patient overpaid you. You may need to issue the patient a refund for the difference between the patient's payment and the amount shown as patient responsibility on this notice
N721
This service is only covered when performed as part of a clinical trial
N722
Patient must use Workers' Compensation Set-Aside funds to pay for the medical service or item
N723
Patient must use Liability set-aside funds to pay for the medical service or item
N724
Patient must use No-Fault set-aside funds to pay for the medical service or item
N725
A liability insurer has reported having ongoing responsibility for medical services for this diagnosis
N726
A conditional payment is not allowed
N727
A no-fault insurer has reported having ongoing responsibility for medical services for this diagnosis
N728
A workers' compensation insurer has reported having ongoing responsibility for medical services for this diagnosis
N729
Missing patient medical/dental record for this service
N730
Incomplete/invalid patient medical/dental record for this service
N731
Incomplete/Invalid mental health assessment
N732
Services performed at an unlicensed facility are not reimbursable
N733
Regulatory surcharges are paid directly to the state
N734
The patient is eligible for these medical services only when unable to work or perform normal activities due to an illness or injury
N736
Incomplete/invalid Sleep Study Report
N737
Missing Sleep Study Report
N738
Incomplete/invalid Vein Study Report
N739
Missing Vein Study Report
N740
The member's Consumer Spending Account does not contain sufficient funds to cover the member's liability for this claim/service
N741
This is a site neutral payment
N743
Adjusted because the services may be related to an employment accident
N744
Adjusted because the services may be related to an auto/other accident
N745
Missing Ambulance Report
N746
Incomplete/invalid Ambulance Report
N747
This is a misdirected claim/service. Submit the claim to the payer/plan where the patient resides
N748
Adjusted because the related hospital charges have not been received
N749
Missing Blood Gas Report
N750
Incomplete/invalid Blood Gas Report
N751
Adjusted because the patient is covered under a Medicare Part D plan
N752
Missing/invalid HIPPS Treatment Authorization Code
N753
Missing/invalid Attachment Control Number
N754
Missing/invalid Referring Provider or Other Source Qualifier on the 1500 Claim Form
N755
Missing/invalid ICD Indicator
N756
Missing/invalid point of drop-off address
N757
Adjusted based on the Federal Indian Fees schedule
N758
Adjusted based on the prior authorization decision
N759
Payment adjusted based on the National Electrical Manufacturers Association Standard XR-29-2013
N760
This facility is not authorized to receive payment for the service(s)
N761
This provider is not authorized to receive payment for the service(s)
N762
This facility is not certified for Tomosynthesis mammography
N763
The demonstration code is not appropriate for this claim; resubmit without a demonstration code
N764
Missing/invalid Hematocrit value
N765
This payer does not cover coinsurance assessed by a previous payer
N766
This payer does not cover co-payment assessed by a previous payer
N767
The Medicaid state requires provider to be enrolled in the member's Medicaid state program prior to any claim benefits being processed
N768
Incomplete/invalid initial evaluation report
N769
A lateral diagnosis is required
N770
The adjustment request received from the provider has been processed. Your original claim has been adjusted based on the information received
N771
Under Federal law you cannot charge more than the limiting charge amount
N772
Rebill urgent/emergent and ancillary services separately
N773
Drug supplied not obtained from specialty vendor
N774
Refer to your Third Party Processor Agreement for specific information on fees associated with this payment type
N775
Payment adjusted based on x-ray radiograph on film
N776
This service is not a covered Telehealth service
N777
Missing Assignment of Benefits Indicator
N778
Missing Primary Care Physician Information
N779
Replacement/Void claims cannot be submitted until the original claim has finalized. Please resubmit once payment or denial is received
N780
Missing/invalid end therapy date
N781
Patient is a Medicaid/ Qualified Medicare Beneficiary. Review your records for any wrongfully collected deductible. This amount may be billed to a subsequent payer
N782
Patient is a Medicaid/ Qualified Medicare Beneficiary. Review your records for any wrongfully collected coinsurance. This amount may be billed to a subsequent payer
N783
Patient is a Medicaid/ Qualified Medicare Beneficiary. Review your records for any wrongfully collected copayment. This amount may be billed to a subsequent payer
N784
Missing comprehensive procedure code
N785
Missing current radiology film/images
N786
Benefit limitation for the orthodontic active and/or retention phase of treatment
N787
Under 42 CFR 410.43, an eligible Partial Hospitalization Program patient/beneficiary requires a minimum of 20 hours of PHP services per week, as evidenced in the plan of care. PHP…
N788
The third-party administrator/review organization did not receive the required information
N789
Clinical Trial is not a covered benefit
N790
Provider/supplier not accredited for product/service
N791
Missing history & physical report
N792
Incomplete/invalid history & physical report
N794
Payment adjusted based on type of technology used
N795
Item must be resubmitted as a purchase
N796
Missing/invalid Hemoglobin value
N797
Missing/invalid date qualifier
N798
Submit a void request for the original claim and resubmit a new claim
N799
Submitted identifier must be an individual identifier, not group identifier
N800
Only one service date is allowed per claim
N801
Services performed in a Medicare participating or CAH facility under a self-insured tribal Group Health Plan, in accordance with Federal Regulation 42 CFR 136
N802
This claim/service is not payable under our service area. The claim must be filed to the Payer/Plan in whose service area the Rendering Physician is located
N803
Submission of the claim for the service rendered is the responsibility of the Contracted Medical Group or Hospital
N804
The claim/service was processed through the Outpatient Code Editor
N805
The claim/service was processed through the Correct Code Editor
N806
Payment is included in the Global transplant allowance
N807
Payment adjustment based on the Merit-based Incentive Payment System
N808
Not covered for this provider type / provider specialty
N809
The fee schedule amount for this service was adjusted based on prior competitive bidding rates. For more information, contact your local contractor
N810
Due to federal, state or local disaster declaration, this claim has been processed at the in-network level of benefit. At the conclusion or expiration of the disaster declaration…
N811
Missing Federal Sequestration Reduction from Prior Payer
N812
The start service date through end service date cannot span greater than 18 months
N815
Missing/invalid NDC Unit Count
N816
Missing/invalid NDC Unit of Measure
N817
Applicable laboratories are required to collect and report private payor data and report that data to CMS between January 1, 2020 - March 31, 2020
N818
Claims Dates of Service do not match Electronic Visit Verification System
N819
Patient not enrolled in Electronic Visit Verification System
N820
Electronic Visit Verification System units do not meet requirements of visit
N821
Electronic Visit Verification System visit not found
N822
Missing procedure modifier(s)
N823
Incomplete/Invalid procedure modifier(s)
N824
Electronic Visit Verification data must be submitted through EVV Vendor
N825
Early intervention guidelines were not met
N826
Patient did not meet the inclusion criteria for the Medicare Shared Savings Program
N827
Missing/invalid Federal Information Processing Standard Code
N828
Payment is suppressed due to a contracted funding
N829
Missing/invalid Diagnostics Exchange Z-Code Identifier
N830
The charge[s] for this service was processed in accordance with Federal/ State, Balance Billing/ No Surprise Billing regulations. As such, any amount identified with OA, CO, or PI…
N831
You have not responded to requests to revalidate your provider/supplier enrollment information
N832
Duplicate occurrence code/occurrence span code
N833
Patient share of cost waived
N834
Jurisdiction exempt from sales and health tax charges
N835
Unrelated Service/procedure/treatment is reduced. The balance of this charge is the patient's responsibility
N836
Provider W9 or Payee Registration not on file
N837
Missing modifier was added
N838
Service/procedure postponed due to a federal, state, or local mandate/disaster declaration. Any amounts applied to deductible or member liability will be applied to the prior plan…
N839
The procedure code was added/changed because the level of service exceeds the compensable condition(s)
N840
Worker's compensation claim filed with a different state
N841
North Dakota Administrative Rule 92-01-02-50.3
N842
Patient cannot be billed for charges
N843
Missing/invalid Core-Based Statistical Area code
N844
This claim, or a portion of this claim, was processed in accordance with the Nebraska Legislative LB997 July 24, 2020 - Out of Network Emergency Medical Care Act
N845
Nebraska Legislative LB997 July 24, 2020 - Out of Network Emergency Medical Care Act
N846
National Drug Code supplied does not correspond to the HCPCs/CPT billed
N847
National Drug Code billed is obsolete
N848
National Drug Code billed cannot be associated with a product
N849
Missing Tooth Clause: Tooth missing prior to the member effective date
N850
Missing/invalid narrative explaining/describing this service/treatment
N851
Payment reduced because services were furnished by a therapy assistant
N852
The pay-to and rendering provider tax identification numbers do not match
N853
The number of modalities performed per session exceeds our acceptable maximum
N854
If you have primary other health insurance coverage that has denied services, you must exhaust all appeal levels with your primary OHI before we can consider your claim for reimbu…
N855
This coverage is subject to the exclusive jurisdiction of ERISA, U.S.C. SEC 1001
N856
This coverage is not subject to the exclusive jurisdiction of ERISA, U.S.C. SEC 1001
N857
This claim has been adjusted/reversed. Refund any collected copayment to the member
N858
State regulations relating to an Out of Network Medical Emergency Care Act were applied to the processing of this claim. Payment amounts are eligible for dispute following the sta…
N859
The Federal No Surprise Billing Act was applied to the processing of this claim. Payment amounts are eligible for dispute pursuant to any Federal documented appeal/ grievance/ dis…
N860
The Federal No Surprise Billing Act Qualified Payment Amount was used to calculate the member cost share(s)
N861
Mismatch between the submitted Patient Liability/Share of Cost and the amount on record for this recipient
N862
Member cost share is in compliance with the No Surprises Act, and is calculated using the lesser of the QPA or billed charge
N863
This claim is subject to the No Surprises Act. The amount paid is the final out-of-network rate and was calculated based on an All Payer Model Agreement, in accordance with the NSA
N864
This claim is subject to the No Surprises Act provisions that apply to emergency services
N865
This claim is subject to the No Surprises Act provisions that apply to nonemergency services furnished by nonparticipating providers during a patient visit to a participating faci…
N866
This claim is subject to the No Surprises Act provisions that apply to services furnished by nonparticipating providers of air ambulance services
N867
Cost sharing was calculated based on a specified state law, in accordance with the No Surprises Act
N868
Cost sharing was calculated based on an All-Payer Model Agreement, in accordance with the No Surprises Act
N869
Cost sharing was calculated based on the qualifying payment amount, in accordance with the No Surprises Act
N870
In accordance with the No Surprises Act, cost sharing was based on the billed amount because the billed amount was lower than the qualifying payment amount
N871
This initial payment was calculated based on a specified state law, in accordance with the No Surprises Act
N872
This final payment was calculated based on a specified state law, in accordance with the No Surprises Act
N873
This final payment was calculated based on an All-Payer Model Agreement, in accordance with the No Surprises Act
N874
This final payment was determined through open negotiation, in accordance with the No Surprises Act
N875
This final payment equals the amount selected as the out-of-network rate by a Federal Independent Dispute Resolution Entity, in accordance with the No Surprises Act
N876
This item or service is covered under the plan. This is a notice of denial of payment provided in accordance with the No Surprises Act. The provider or facility may initiate open…
N877
This initial payment is provided in accordance with the No Surprises Act. The provider or facility may initiate open negotiation if they desire to negotiate a higher out-of-networ…
N878
The provider or facility specified that notice was provided and consent to balance bill obtained, but notice and consent was not provided and obtained in a manner consistent with…
N879
The notice and consent to balance bill, and to be charged out-of-network cost sharing, that was obtained from the patient with regard to the billed services, is not permitted for…
N880
Original claim closed due to changes in submitted data. Adjustment claim will be processed under a new claim number
N881
Client Obligation, patient responsibility for Home & Community Based Services
N882
The out-of-network payment and cost sharing amounts were based on the plan's allowance because the provider or facility obtained the patient's consent to waive the balance billing…
N883
Processed according to state law
N884
The No Surprises Act may apply to this claim. Please contact payer for instructions on how to submit information regarding whether or not the item or service was furnished during…
N885
This claim was not processed in accordance with the No Surprises Act cost-sharing or out-of-network payment requirements. The payer disagrees with your determination that those re…
N886
A Health Care Claim Request for Additional Information has been sent
N887
Providers not participating in the Medicare Advantage Plan have the right to appeal if the plan has partially or fully denied payment or if the provider believes the plan has not…
N888
An electronic request for additional information has been sent for this claim
N889
This claim was originally processed in real-time, and we sent a real-time 835 response
N890
Electronic Visit Verification Data Element Requirements were not met
N891
The maximum allowable payment for this service/procedure was paid by the primary insurance. No further payment due
N892
The claim does not meet the criteria for acceptable use of the Delay Reason Code
N893
Missing/invalid child medical evaluation form/checklist
N894
These payments are made subject to a reservation of rights for the Payor to recoup or otherwise recover all or part of these payments based on any of the following: outcome of pen…
N895
Processed based on a negotiated fee schedule for a specialty drug program
N896
Missing/invalid trauma activation sheet
N897
Missing/invalid proof of member payment
N898
Missing/invalid Resource Utilization Group(s) code(s)
N899
Missing Initial Evaluation Report
N900
Missing Therapy Notes/Report
N901
Incomplete/Invalid Therapy Notes/Report
N902
Missing Health Risk Assessment
N903
Incomplete/Invalid Health Risk Assessment
N904
The transportation vendor is responsible for this claim
N905
Provider opted out of Medicare; claim not payable. Patient is responsible, subject to limiting charge rules if applicable.
N906
Service is not covered when patient is under age 45
N907
No refund because this claim has been identified as 340B-eligible with a ceiling price lower than the maximum fair price
N908
No refund because this drug has been prospectively purchased at the maximum fair price
N909
Refund amount has been calculated using a methodology that differs from the Standard Default Refund Amount calculation times Quantity)
N910
A refund cannot be provided for this claim at this time. Contact the manufacturer directly regarding your eligibility
N911
This claim cannot be reimbursed by the manufacturer until the Part D plan submits corrected prescription drug event data to CMS for maximum fair price validation
N912
Our records indicate that this beneficiary did not elect hospice
N913
More than one Electronic Visit Verification record exists for the date and time of this service
N914
This claim was priced and processed in accordance with California AB-72 Health care coverage
N915
Predetermination of services is not allowed under the member's plan
N916
The third party will render payment to the provider, and they will reimburse you for covered services
N917
Alternative refund amount has been calculated because the maximum fair price is below the 340B ceiling price
N918
No refund because CMS excludes prescription drug event records when a compound code indicates it is for a compounded drug
N919
Family/member out-of-pocket maximum has been met
N920
Payment to the provider has been placed on hold as a result of active contractnegotiation
N921
The time limit for filing a reconsideration or appeal has expired
N922
Missing primary care dentist information

FAQ

What are RARC N-series codes?
RARC N-series codes are Remittance Advice Remark Codes that supplement a claim adjustment reason code (CARC) on the EOB/ERA with extra detail. This page lists all 887 active N-series codes and their meanings.
What is the difference between a CARC and a RARC?
A CARC states why a claim line was adjusted or denied; a RARC adds clarifying detail. A claim line can carry one CARC plus one or more RARCs.

← Back to the full denial codes lookup · CARC codes have individual pages; RARC are grouped by series. · POS codes

Reference only — CARC/RARC are national code sets updated periodically. Verify against the current official list before acting on a denial.