Remark Code List N6..
N600 Adjusted based on the applicable fee schedule for the region in which the service was rendered.
Start: 07/15/2013
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 System applicable to Hawaii.
Start: 07/15/2013
N602 Adjusted based on the Redbook maximum allowance.
Start: 07/15/2013
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.
Start: 07/15/2013
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 Regulation 83 and / or Appendix 17-C of 11 NYCRR.
Start: 07/15/2013
N605 This fee was calculated based upon New York All Patients Refined Diagnosis Related Groups (APR-DRG), pursuant to Regulation 68.
Start: 07/15/2013
N606 The Oregon allowed amount for this procedure is based upon the Workers Compensation Fee Schedule (OAR 436-009). The allowed amount has been calculated in accordance with Section 4 of ORS 742.524.
Start: 07/15/2013
N607 Service provided for non-compensable condition(s).
Start: 07/15/2013
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.
Start: 07/15/2013
N609 80% of the provider's billed amount is being recommended for payment according to Act 6.
Start: 07/15/2013 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N610 Alert: Payment based on an appropriate level of care.
Start: 07/15/2013
N611 Claim in litigation. Contact insurer for more information.
Start: 07/15/2013
N612 Medical provider not authorized/certified to provide treatment to injured workers in this jurisdiction.
Start: 07/15/2013
N613 Alert: 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 on the claim is accurate and if it is, contact the ordering provider instructing them to update their enrollment record. Unless corrected, a claim with this ordering provider will not be paid in the future.
Start: 07/15/2013
N614 Alert: Additional information is included in the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information).
Start: 07/15/2013
N615 Alert: 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 Health Plan issuer must pay all appropriate claims for services rendered to the enrollee during the first month of the grace period and may pend claims for services rendered to the enrollee in the second and third months of the grace period.
Start: 07/15/2013 | Last Modified: 03/01/2017
Notes: (Modified 3/1/2017)
N616 Alert: This enrollee is in the first month of the advance premium tax credit grace period.
Start: 07/15/2013
N617 This enrollee is in the second or third month of the advance premium tax credit grace period.
Start: 07/15/2013
N618 Alert: This claim will automatically be reprocessed if the enrollee pays their premiums.
Start: 07/15/2013
N619 Coverage terminated for non-payment of premium.
Start: 07/15/2013
N620 Alert: This procedure code is for quality reporting/informational purposes only.
Start: 07/15/2013
N621 Charges for Jurisdiction required forms, reports, or chart notes are not payable.
Start: 07/15/2013
N622 Not covered based on the date of injury/accident.
Start: 07/15/2013
N623 Not covered when deemed unscientific/unproven/outmoded/experimental/excessive/inappropriate.
Start: 07/15/2013
N624 The associated Workers' Compensation claim has been withdrawn.
Start: 07/15/2013
N625 Missing/Incomplete/Invalid Workers' Compensation Claim Number.
Start: 07/15/2013
N626 New or established patient E/M codes are not payable with chiropractic care codes.
Start: 07/15/2013
N627 Service not payable per managed care contract.
Start: 07/15/2013 | Stop: 07/01/2014
Notes: Consider Use CARC 256
N628 Out-patient follow up visits on the same date of service as a scheduled test or treatment is disallowed.
Start: 07/15/2013
N629 Reviews/documentation/notes/summaries/reports/charts not requested.
Start: 07/15/2013
N630 Referral not authorized by attending physician.
Start: 07/15/2013
N631 Medical Fee Schedule does not list this code. An allowance was made for a comparable service.
Start: 07/15/2013
N632 According to the Official Medical Fee Schedule this service has a relative value of zero and therefore no payment is due.
Start: 07/15/2013 | Stop: 07/01/2014
Notes: Consider using W8
N633 Additional anesthesia time units are not allowed.
Start: 07/15/2013
N634 The allowance is calculated based on anesthesia time units.
Start: 07/15/2013
N635 The Allowance is calculated based on the anesthesia base units plus time.
Start: 07/15/2013
N636 Adjusted because this is reimbursable only once per injury.
Start: 07/15/2013
N637 Consultations are not allowed once treatment has been rendered by the same provider.
Start: 07/15/2013
N638 Reimbursement has been made according to the home health fee schedule.
Start: 07/15/2013
N639 Reimbursement has been made according to the inpatient rehabilitation facilities fee schedule.
Start: 07/15/2013
N640 Exceeds number/frequency approved/allowed within time period.
Start: 07/15/2013
N641 Reimbursement has been based on the number of body areas rated.
Start: 07/15/2013
N642 Adjusted when billed as individual tests instead of as a panel.
Start: 07/15/2013
N643 The services billed are considered Not Covered or Non-Covered (NC) in the applicable state fee schedule.
Start: 07/15/2013
N644 Reimbursement has been made according to the bilateral procedure rule.
Start: 07/15/2013
N645 Mark-up allowance.
Start: 07/15/2013 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N646 Reimbursement has been adjusted based on the guidelines for an assistant.
Start: 07/15/2013
N647 Adjusted based on diagnosis-related group (DRG).
Start: 07/15/2013
N648 Adjusted based on Stop Loss.
Start: 07/15/2013
N649 Payment based on invoice.
Start: 07/15/2013
N650 This policy was not in effect for this date of loss. No coverage is available.
Start: 07/15/2013
N651 No Personal Injury Protection/Medical Payments Coverage on the policy at the time of the loss.
Start: 07/15/2013
N652 The date of service is before the date of loss.
Start: 07/15/2013
N653 The date of injury does not match the reported date of loss.
Start: 07/15/2013
N654 Adjusted based on achievement of maximum medical improvement (MMI).
Start: 07/15/2013
N655 Payment based on provider's geographic region.
Start: 07/15/2013
N656 An interest payment is being made because benefits are being paid outside the statutory requirement.
Start: 07/15/2013
N657 This should be billed with the appropriate code for these services.
Start: 07/15/2013
N658 The billed service(s) are not considered medical expenses.
Start: 07/15/2013
N659 This item is exempt from sales tax.
Start: 07/15/2013
N660 Sales tax has been included in the reimbursement.
Start: 07/15/2013
N661 Documentation does not support that the services rendered were medically necessary.
Start: 07/15/2013
N662 Alert: Consideration of payment will be made upon receipt of a final bill.
Start: 07/15/2013
N663 Adjusted based on an agreed amount.
Start: 07/15/2013
N664 Adjusted based on a legal settlement.
Start: 07/15/2013
N665 Services by an unlicensed provider are not reimbursable.
Start: 07/15/2013
N666 Only one evaluation and management code at this service level is covered during the course of care.
Start: 07/15/2013
N667 Missing prescription.
Start: 07/15/2013 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N668 Incomplete/invalid prescription.
Start: 07/15/2013 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N669 Adjusted based on the Medicare fee schedule.
Start: 07/15/2013
N670 This service code has been identified as the primary procedure code subject to the Medicare Multiple Procedure Payment Reduction (MPPR) rule.
Start: 07/15/2013
N671 Payment based on a jurisdiction cost-charge ratio.
Start: 07/15/2013
N672 Alert: Amount applied to Health Insurance Offset.
Start: 07/15/2013
N673 Reimbursement has been calculated based on an outpatient per diem or an outpatient factor and/or fee schedule amount.
Start: 07/15/2013
N674 Not covered unless a pre-requisite procedure/service has been provided.
Start: 07/15/2013
N675 Additional information is required from the injured party.
Start: 07/15/2013
N676 Service does not qualify for payment under the Outpatient Facility Fee Schedule.
Start: 07/15/2013
N677 Alert: Films/Images will not be returned.
Start: 11/01/2013
N678 Missing post-operative images/visual field results.
Start: 11/01/2013
N679 Incomplete/Invalid post-operative images/visual field results.
Start: 11/01/2013
N680 Missing/Incomplete/Invalid date of previous dental extractions.
Start: 11/01/2013
N681 Missing/Incomplete/Invalid full arch series.
Start: 11/01/2013
N682 Missing/Incomplete/Invalid history of prior periodontal therapy/maintenance.
Start: 11/01/2013
N683 Missing/Incomplete/Invalid prior treatment documentation.
Start: 11/01/2013
N684 Payment denied as this is a specialty claim submitted as a general claim.
Start: 11/01/2013
N685 Missing/Incomplete/Invalid Prosthesis, Crown or Inlay Code.
Start: 11/01/2013
N686 Missing/incomplete/Invalid questionnaire needed to complete payment determination.
Start: 11/01/2013
N687 Alert: This reversal is due to a retroactive disenrollment.
Start: 11/01/2013 | Last Modified: 03/14/2014
Notes: To be used with claim/service reversal. (Modified 3/14/2014)
N688 Alert: This reversal is due to a medical or utilization review decision.
Start: 11/01/2013 | Last Modified: 03/14/2014
Notes: To be used with claim/service reversal. (Modified 3/14/2014)
N689 Alert: This reversal is due to a retroactive rate change.
Start: 11/01/2013 | Last Modified: 03/14/2014
Notes: To be used with claim/service reversal. (Modified 3/14/2014)
N690 Alert: This reversal is due to a provider submitted appeal.
Start: 11/01/2013 | Last Modified: 03/14/2014
Notes: To be used with claim/service reversal. (Modified 3/14/2014)
N691 Alert: This reversal is due to a patient submitted appeal.
Start: 11/01/2013 | Last Modified: 03/14/2014
Notes: To be used with claim/service reversal. (Modified 3/14/2014)
N692 Alert: This reversal is due to an incorrect rate on the initial adjudication.
Start: 11/01/2013 | Last Modified: 03/14/2014
Notes: To be used with claim/service reversal. (Modified 3/14/2014)
N693 Alert: This reversal is due to a cancellation of the claim by the provider.
Start: 11/01/2013 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N694 Alert: This reversal is due to a resubmission/change to the claim by the provider.
Start: 11/01/2013
N695 Alert: This reversal is due to incorrect patient financial responsibility information on the initial adjudication.
Start: 11/01/2013
N696 Alert: This reversal is due to a Coordination of Benefits or Third Party Liability Recovery retroactive adjustment.
Start: 11/01/2013 | Last Modified: 03/14/2014
Notes: To be used with claim/service reversal. (Modified 3/14/2014)
N697 Alert: This reversal is due to a payer's retroactive contract incentive program adjustment.
Start: 11/01/2013 | Last Modified: 03/14/2014
Notes: To be used with claim/service reversal. (Modified 3/14/2014)
N698 Alert: This reversal is due to non-payment of the health insurance premiums (Health Insurance Exchange or other) by the end of the premium payment grace period, resulting in loss of coverage.
Start: 11/01/2013 | Last Modified: 11/01/2015
Notes: To be used with claim/service reversal. (Modified 3/14/2014, 11/1/2015)
N699 Payment adjusted based on the Physician Quality Reporting System (PQRS) Incentive Program.
Start: 03/01/2014
N600 Adjusted based on the applicable fee schedule for the region in which the service was rendered.
Start: 07/15/2013
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 System applicable to Hawaii.
Start: 07/15/2013
N602 Adjusted based on the Redbook maximum allowance.
Start: 07/15/2013
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.
Start: 07/15/2013
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 Regulation 83 and / or Appendix 17-C of 11 NYCRR.
Start: 07/15/2013
N605 This fee was calculated based upon New York All Patients Refined Diagnosis Related Groups (APR-DRG), pursuant to Regulation 68.
Start: 07/15/2013
N606 The Oregon allowed amount for this procedure is based upon the Workers Compensation Fee Schedule (OAR 436-009). The allowed amount has been calculated in accordance with Section 4 of ORS 742.524.
Start: 07/15/2013
N607 Service provided for non-compensable condition(s).
Start: 07/15/2013
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.
Start: 07/15/2013
N609 80% of the provider's billed amount is being recommended for payment according to Act 6.
Start: 07/15/2013 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N610 Alert: Payment based on an appropriate level of care.
Start: 07/15/2013
N611 Claim in litigation. Contact insurer for more information.
Start: 07/15/2013
N612 Medical provider not authorized/certified to provide treatment to injured workers in this jurisdiction.
Start: 07/15/2013
N613 Alert: 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 on the claim is accurate and if it is, contact the ordering provider instructing them to update their enrollment record. Unless corrected, a claim with this ordering provider will not be paid in the future.
Start: 07/15/2013
N614 Alert: Additional information is included in the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information).
Start: 07/15/2013
N615 Alert: 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 Health Plan issuer must pay all appropriate claims for services rendered to the enrollee during the first month of the grace period and may pend claims for services rendered to the enrollee in the second and third months of the grace period.
Start: 07/15/2013 | Last Modified: 03/01/2017
Notes: (Modified 3/1/2017)
N616 Alert: This enrollee is in the first month of the advance premium tax credit grace period.
Start: 07/15/2013
N617 This enrollee is in the second or third month of the advance premium tax credit grace period.
Start: 07/15/2013
N618 Alert: This claim will automatically be reprocessed if the enrollee pays their premiums.
Start: 07/15/2013
N619 Coverage terminated for non-payment of premium.
Start: 07/15/2013
N620 Alert: This procedure code is for quality reporting/informational purposes only.
Start: 07/15/2013
N621 Charges for Jurisdiction required forms, reports, or chart notes are not payable.
Start: 07/15/2013
N622 Not covered based on the date of injury/accident.
Start: 07/15/2013
N623 Not covered when deemed unscientific/unproven/outmoded/experimental/excessive/inappropriate.
Start: 07/15/2013
N624 The associated Workers' Compensation claim has been withdrawn.
Start: 07/15/2013
N625 Missing/Incomplete/Invalid Workers' Compensation Claim Number.
Start: 07/15/2013
N626 New or established patient E/M codes are not payable with chiropractic care codes.
Start: 07/15/2013
N627 Service not payable per managed care contract.
Start: 07/15/2013 | Stop: 07/01/2014
Notes: Consider Use CARC 256
N628 Out-patient follow up visits on the same date of service as a scheduled test or treatment is disallowed.
Start: 07/15/2013
N629 Reviews/documentation/notes/summaries/reports/charts not requested.
Start: 07/15/2013
N630 Referral not authorized by attending physician.
Start: 07/15/2013
N631 Medical Fee Schedule does not list this code. An allowance was made for a comparable service.
Start: 07/15/2013
N632 According to the Official Medical Fee Schedule this service has a relative value of zero and therefore no payment is due.
Start: 07/15/2013 | Stop: 07/01/2014
Notes: Consider using W8
N633 Additional anesthesia time units are not allowed.
Start: 07/15/2013
N634 The allowance is calculated based on anesthesia time units.
Start: 07/15/2013
N635 The Allowance is calculated based on the anesthesia base units plus time.
Start: 07/15/2013
N636 Adjusted because this is reimbursable only once per injury.
Start: 07/15/2013
N637 Consultations are not allowed once treatment has been rendered by the same provider.
Start: 07/15/2013
N638 Reimbursement has been made according to the home health fee schedule.
Start: 07/15/2013
N639 Reimbursement has been made according to the inpatient rehabilitation facilities fee schedule.
Start: 07/15/2013
N640 Exceeds number/frequency approved/allowed within time period.
Start: 07/15/2013
N641 Reimbursement has been based on the number of body areas rated.
Start: 07/15/2013
N642 Adjusted when billed as individual tests instead of as a panel.
Start: 07/15/2013
N643 The services billed are considered Not Covered or Non-Covered (NC) in the applicable state fee schedule.
Start: 07/15/2013
N644 Reimbursement has been made according to the bilateral procedure rule.
Start: 07/15/2013
N645 Mark-up allowance.
Start: 07/15/2013 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N646 Reimbursement has been adjusted based on the guidelines for an assistant.
Start: 07/15/2013
N647 Adjusted based on diagnosis-related group (DRG).
Start: 07/15/2013
N648 Adjusted based on Stop Loss.
Start: 07/15/2013
N649 Payment based on invoice.
Start: 07/15/2013
N650 This policy was not in effect for this date of loss. No coverage is available.
Start: 07/15/2013
N651 No Personal Injury Protection/Medical Payments Coverage on the policy at the time of the loss.
Start: 07/15/2013
N652 The date of service is before the date of loss.
Start: 07/15/2013
N653 The date of injury does not match the reported date of loss.
Start: 07/15/2013
N654 Adjusted based on achievement of maximum medical improvement (MMI).
Start: 07/15/2013
N655 Payment based on provider's geographic region.
Start: 07/15/2013
N656 An interest payment is being made because benefits are being paid outside the statutory requirement.
Start: 07/15/2013
N657 This should be billed with the appropriate code for these services.
Start: 07/15/2013
N658 The billed service(s) are not considered medical expenses.
Start: 07/15/2013
N659 This item is exempt from sales tax.
Start: 07/15/2013
N660 Sales tax has been included in the reimbursement.
Start: 07/15/2013
N661 Documentation does not support that the services rendered were medically necessary.
Start: 07/15/2013
N662 Alert: Consideration of payment will be made upon receipt of a final bill.
Start: 07/15/2013
N663 Adjusted based on an agreed amount.
Start: 07/15/2013
N664 Adjusted based on a legal settlement.
Start: 07/15/2013
N665 Services by an unlicensed provider are not reimbursable.
Start: 07/15/2013
N666 Only one evaluation and management code at this service level is covered during the course of care.
Start: 07/15/2013
N667 Missing prescription.
Start: 07/15/2013 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N668 Incomplete/invalid prescription.
Start: 07/15/2013 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N669 Adjusted based on the Medicare fee schedule.
Start: 07/15/2013
N670 This service code has been identified as the primary procedure code subject to the Medicare Multiple Procedure Payment Reduction (MPPR) rule.
Start: 07/15/2013
N671 Payment based on a jurisdiction cost-charge ratio.
Start: 07/15/2013
N672 Alert: Amount applied to Health Insurance Offset.
Start: 07/15/2013
N673 Reimbursement has been calculated based on an outpatient per diem or an outpatient factor and/or fee schedule amount.
Start: 07/15/2013
N674 Not covered unless a pre-requisite procedure/service has been provided.
Start: 07/15/2013
N675 Additional information is required from the injured party.
Start: 07/15/2013
N676 Service does not qualify for payment under the Outpatient Facility Fee Schedule.
Start: 07/15/2013
N677 Alert: Films/Images will not be returned.
Start: 11/01/2013
N678 Missing post-operative images/visual field results.
Start: 11/01/2013
N679 Incomplete/Invalid post-operative images/visual field results.
Start: 11/01/2013
N680 Missing/Incomplete/Invalid date of previous dental extractions.
Start: 11/01/2013
N681 Missing/Incomplete/Invalid full arch series.
Start: 11/01/2013
N682 Missing/Incomplete/Invalid history of prior periodontal therapy/maintenance.
Start: 11/01/2013
N683 Missing/Incomplete/Invalid prior treatment documentation.
Start: 11/01/2013
N684 Payment denied as this is a specialty claim submitted as a general claim.
Start: 11/01/2013
N685 Missing/Incomplete/Invalid Prosthesis, Crown or Inlay Code.
Start: 11/01/2013
N686 Missing/incomplete/Invalid questionnaire needed to complete payment determination.
Start: 11/01/2013
N687 Alert: This reversal is due to a retroactive disenrollment.
Start: 11/01/2013 | Last Modified: 03/14/2014
Notes: To be used with claim/service reversal. (Modified 3/14/2014)
N688 Alert: This reversal is due to a medical or utilization review decision.
Start: 11/01/2013 | Last Modified: 03/14/2014
Notes: To be used with claim/service reversal. (Modified 3/14/2014)
N689 Alert: This reversal is due to a retroactive rate change.
Start: 11/01/2013 | Last Modified: 03/14/2014
Notes: To be used with claim/service reversal. (Modified 3/14/2014)
N690 Alert: This reversal is due to a provider submitted appeal.
Start: 11/01/2013 | Last Modified: 03/14/2014
Notes: To be used with claim/service reversal. (Modified 3/14/2014)
N691 Alert: This reversal is due to a patient submitted appeal.
Start: 11/01/2013 | Last Modified: 03/14/2014
Notes: To be used with claim/service reversal. (Modified 3/14/2014)
N692 Alert: This reversal is due to an incorrect rate on the initial adjudication.
Start: 11/01/2013 | Last Modified: 03/14/2014
Notes: To be used with claim/service reversal. (Modified 3/14/2014)
N693 Alert: This reversal is due to a cancellation of the claim by the provider.
Start: 11/01/2013 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N694 Alert: This reversal is due to a resubmission/change to the claim by the provider.
Start: 11/01/2013
N695 Alert: This reversal is due to incorrect patient financial responsibility information on the initial adjudication.
Start: 11/01/2013
N696 Alert: This reversal is due to a Coordination of Benefits or Third Party Liability Recovery retroactive adjustment.
Start: 11/01/2013 | Last Modified: 03/14/2014
Notes: To be used with claim/service reversal. (Modified 3/14/2014)
N697 Alert: This reversal is due to a payer's retroactive contract incentive program adjustment.
Start: 11/01/2013 | Last Modified: 03/14/2014
Notes: To be used with claim/service reversal. (Modified 3/14/2014)
N698 Alert: This reversal is due to non-payment of the health insurance premiums (Health Insurance Exchange or other) by the end of the premium payment grace period, resulting in loss of coverage.
Start: 11/01/2013 | Last Modified: 11/01/2015
Notes: To be used with claim/service reversal. (Modified 3/14/2014, 11/1/2015)
N699 Payment adjusted based on the Physician Quality Reporting System (PQRS) Incentive Program.
Start: 03/01/2014
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