The following is the latest update of Remittance Advice Remark Codes used in electronic and paper remittance advice and Claim Adjustment Reason Codes used in electronic and paper remittance advice and coordination of benefits (COB) claim transactions. Effective Date: January 1, 2008
| Code |
Current Narrative |
Comment |
| N388 |
Missing/incomplete/invalid prescription number. Note: (New Code 8/1/07) |
Medicare initiated |
| N389 |
Duplicate prescription number submitted. Note: (New Code 8/1/07) |
Medicare initiated |
| N390 |
This service cannot be billed separately. Note: (New Code 8/1/07) |
Medicare initiated |
| N391 |
Missing emergency department records. Note: (New Code 8/1/07) |
Not Medicare initiated |
| N392 |
Incomplete/invalid emergency department records. Note: (New Code 8/1/07) |
Not Medicare initiated |
| N393 |
Missing progress notes or report. Note: (New Code 8/1/07) |
Not Medicare initiated |
| N394 |
Incomplete/invalid progress notes or report. Note: (New Code 8/1/07) |
Not Medicare initiated |
| N395 |
Missing laboratory report. Note: (New Code 8/1/07) |
Not Medicare initiated |
| N396 |
Incomplete/invalid laboratory report. Note: (New Code 8/1/07) |
Not Medicare initiated |
| N397 |
Benefits are not available for incomplete service(s)/undelivered item(s). Note: (New Code 8/1/07) |
Not Medicare initiated |
| N398 |
Missing elective consent form. Note: (New Code 8/1/07) |
Not Medicare initiated |
| N399 |
Incomplete/invalid elective consent form. Note: (New Code 8/1/07) |
Not Medicare initiated |
| N400 |
Alert: Electronically enabled providers should submit claims electronically. Note: (New Code 8/1/07) |
Not Medicare initiated |
| N401 |
Missing periodontal charting. Note: (New Code 8/1/07) |
Not Medicare initiated |
| N402 |
Incomplete/invalid periodontal charting. Note: (New Code 8/1/07) |
Not Medicare initiated |
| N403 |
Missing facility certification. Note: (New Code 8/1/07) |
Not Medicare initiated |
| N404 |
Incomplete/invalid facility certification. Note: (New Code 8/1/07) |
Not Medicare initiated |
| N405 |
This service is only covered when the donor's insurer(s) do not provide coverage for the service. Note: (New Code 8/1/07) |
Not Medicare initiated |
| N406 |
This service is only covered when the recipient's insurer(s) do not provide coverage for the service. Note: (New Code 8/1/07) |
Not Medicare initiated |
| N407 |
You are not an approved submitter for this transmission format. Note: (New Code 8/1/07) |
Medicare initiated |
| N408 |
This payer does not cover deductibles assessed by a previous payer. Note: (New Code 8/1/07) |
Not Medicare initiated |
| 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. Note: (New Code 8/1/07) |
Not Medicare initiated |
| N410 |
This is not covered unless the prescription changes. Note: (New Code 8/1/07) |
Not Medicare initiated |
| N411 |
This service is allowed one time in a 6-month period. (This temporary code will be deactivated on 2/1/09. Must be used with Reason Code 119.) Note: (New Code 8/1/07) |
Not Medicare initiated |
| N412 |
This service is allowed 2 times in a 12-month period. (This temporary code will be deactivated on 2/1/09. Must be used with Reason Code 119.) Note: (New Code 8/1/07) |
Not Medicare initiated |
| N413 |
This service is allowed 2 times in a benefit year. (This temporary code will be deactivated on 2/1/09. Must be used with Reason Code 119.) Note: (New Code 8/1/07) |
Not Medicare initiated |
| N414 |
This service is allowed 4 times in a 12-month period. (This temporary code will be deactivated on 2/1/09. Must be used with Reason Code 119.) Note: (New Code 8/1/07) |
Not Medicare initiated |
| N415 |
This service is allowed 1 time in an 18-month period. (This temporary code will be deactivated on 2/1/09. Must be used with Reason Code 119.) Note: (New Code 8/1/07) |
Not Medicare initiated |
| N416 |
This service is allowed 1 time in a 3-year period. (This temporary code will be deactivated on 2/1/09. Must be used with Reason Code 119.) Note: (New Code 8/1/07) |
Not Medicare initiated |
| N417 |
This service is allowed 1 time in a 5-year period. (This temporary code will be deactivated on 2/1/09. Must be used with Reason Code 119.) Note: (New Code 8/1/07) |
Not Medicare initiated |
| N418 |
Misrouted claim. See the payerÕs claim submission instructions. Note: (New Code 8/1/07) |
Not Medicare initiated |
| N419 |
Claim payment was the result of a payerÕs retroactive adjustment due to a retroactive rate change. Note: (New Code 8/1/07) |
Not Medicare initiated |
| N420 |
Claim payment was the result of a payerÕs retroactive adjustment due to a Coordination of Benefits or Third Party Liability Recovery. Note: (New Code 8/1/07) |
Not Medicare initiated |
| N421 |
Claim payment was the result of a payerÕs retroactive adjustment due to a Peer Review Organization decision. Note: (New Code 8/1/07) |
Not Medicare initiated |
| N422 |
Claim payment was the result of a payerÕs retroactive adjustment due to a payerÑs contract incentive program. Note: (New Code 8/1/07) |
Not Medicare initiated |
| N423 |
Claim payment was the result of a payerÕs retroactive adjustment due to a non standard program. Note: (New Code 8/1/07) |
Not Medicare initiated |
| N424 |
Patient does not reside in the geographic area required for this type of payment. Note: (New Code 8/1/07) |
Medicare initiated |
| N425 |
Statutorily excluded service(s).Note: (New Code 8/1/07) |
Medicare initiated |
| N426 |
No coverage when self-administered. Note: (New Code 8/1/07) |
Medicare initiated |
| N427 |
Payment for eyeglasses or contact lenses can be made only after cataract surgery. Note: (New Code 8/1/07) |
Medicare initiated |
| N428 |
Service/procedure not covered when performed in this place of service. Note: (New Code 8/1/07) |
Medicare initiated |
| N429 |
This is not covered since it is considered routine. Note: (New Code 8/1/07) |
Medicare initiated |
| Code |
Current Narrative |
Comment |
| M27 |
Alert: The patient has been relieved of liability of payment of these items and services under the limitation of liability provision of the law. The provider is ultimately liable for the patientÕs waived charges, including any charges for coinsurance, since the items or services were not reasonable and necessary or constituted custodial care, and you knew or could reasonably have been expected to know, that they were not covered. You may appeal this determination. You may ask for an appeal regarding both the coverage determination and the issue of whether you exercised due care. The appeal request must be filed within 120 days of the date you receive this notice. You must make the request through this office. |
|
| M70 |
Alert: The patient is a member of an employer-sponsored prepaid health plan. Services from outside that health plan are not covered. However, as you were not previously notified of this, we are paying this time. In the future, we will not pay you for non-plan services. |
Modified 4/1/07, 8/1/07 |
| MA14 |
Alert: The patient is a member of an employer-sponsored prepaid health plan. Services from outside that health plan are not covered. However, as you were not previously notified of this, we are paying this time. In the future, we will not pay you for non-plan services. |
Modified 4/1/07, 8/1/07 |
| M62 |
Alert: This is a telephone review decision. |
Modified 4/1/07, 8/1/07 |
| 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 portion of the charge that would have been covered by Medicare.) |
Modified 8/1/07 |
| N84 |
Alert: Further installment payments are forthcoming. |
Modified 4/1/07, 8/1/07 |
| N85 |
Alert: This is the final installment payment. |
Modified 4/1/07, 8/1/07 |
| N129 |
Not eligible due to the patientÕs age. |
New Code 10/31/02, Modified 8/1/07 |
