Tuesday 11 June 2019

N5XX series Remark Code List

N5..Series Remittance Advice Code

N500 Incomplete/invalid Medical Legal Report.
Start: 07/01/2008
N501 Missing Vocational Report.
Start: 07/01/2008
N502 Incomplete/invalid Vocational Report.
Start: 07/01/2008
N503 Missing Work Status Report.
Start: 07/01/2008
N504 Incomplete/invalid Work Status Report.
Start: 07/01/2008
N505 Alert: 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.
Start: 11/01/2008 | Last Modified: 03/01/2017
Notes: (Modified 3/1/2017)
N506 Alert: 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 determined when the claim is processed. This is not a pre-authorization or a guarantee of payment.
Start: 11/01/2008
N507 Plan distance requirements have not been met.
Start: 11/01/2008
N508 Alert: This real-time claim adjudication response represents the member responsibility to the provider for services reported. The member will receive an Explanation of Benefits electronically or in the mail. Contact the insurer if there are any questions.
Start: 11/01/2008 | Last Modified: 03/01/2017
Notes: (Modified 3/1/2017)
N509 Alert: 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 Spending Account will depend on the availability of funds and determination of eligible services at the time of payment processing.
Start: 11/01/2008
N510 Alert: 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 Consumer Spending Account will depend on the availability of funds and determination of eligible services at the time of payment processing.
Start: 11/01/2008
N511 Alert: Information on the availability of Consumer Spending Account funds to cover the member liability on this claim/service is not available at this time.
Start: 11/01/2008
N512 Alert: This is the initial remit of a non-NCPDP claim originally submitted real-time without change to the adjudication.
Start: 11/01/2008
N513 Alert: This is the initial remit of a non-NCPDP claim originally submitted real-time with a change to the adjudication.
Start: 11/01/2008
N514 Consult plan benefit documents/guidelines for information about restrictions for this service.
Start: 11/01/2008 | Stop: 01/01/2011
Notes: Consider using N130
N515 Alert: Submit this claim to the patient's other insurer for potential payment of supplemental benefits. We did not forward the claim information. (use N387 instead)
Start: 11/01/2008 | Stop: 10/01/2009
N516 Records indicate a mismatch between the submitted NPI and EIN.
Start: 03/01/2009
N517 Resubmit a new claim with the requested information.
Start: 03/01/2009
N518 No separate payment for accessories when furnished for use with oxygen equipment.
Start: 03/01/2009
N519 Invalid combination of HCPCS modifiers.
Start: 07/01/2009
N520 Alert: Payment made from a Consumer Spending Account.
Start: 07/01/2009
N521 Mismatch between the submitted provider information and the provider information stored in our system.
Start: 11/01/2009
N522 Duplicate of a claim processed, or to be processed, as a crossover claim.
Start: 11/01/2009 | Last Modified: 03/01/2010
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.
Start: 03/01/2010
N524 Based on policy this payment constitutes payment in full.
Start: 03/01/2010
N525 These services are not covered when performed within the global period of another service.
Start: 03/01/2010
N526 Not qualified for recovery based on employer size.
Start: 03/01/2010
N527 We processed this claim as the primary payer prior to receiving the recovery demand.
Start: 03/01/2010
N528 Patient is entitled to benefits for Institutional Services only.
Start: 03/01/2010 | Last Modified: 07/01/2010
Notes: (Modified 7/1/10)
N529 Patient is entitled to benefits for Professional Services only.
Start: 03/01/2010 | Last Modified: 07/01/2010
Notes: (Modified 7/1/10)
N530 Not Qualified for Recovery based on enrollment information.
Start: 03/01/2010 | Last Modified: 07/01/2010
Notes: (Modified 7/1/10)
N531 Not qualified for recovery based on direct payment of premium.
Start: 03/01/2010
N532 Not qualified for recovery based on disability and working status.
Start: 03/01/2010
N533 Services performed in an Indian Health Services facility under a self-insured tribal Group Health Plan.
Start: 07/01/2010
N534 This is an individual policy, the employer does not participate in plan sponsorship.
Start: 07/01/2010
N535 Payment is adjusted when procedure is performed in this place of service based on the submitted procedure code and place of service.
Start: 07/01/2010
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.
Start: 07/01/2010
N537 We have examined claims history and no records of the services have been found.
Start: 07/01/2010
N538 A facility is responsible for payment to outside providers who furnish these services/supplies/drugs to its patients/residents.
Start: 07/01/2010
N539 Alert: We processed appeals/waiver requests on your behalf and that request has been denied.
Start: 07/01/2010
N540 Payment adjusted based on the interrupted stay policy.
Start: 11/01/2010
N541 Mismatch between the submitted insurance type code and the information stored in our system.
Start: 11/01/2010
N542 Missing income verification.
Start: 03/08/2011
N543 Incomplete/invalid income verification.
Start: 03/08/2011 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N544 Alert: 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.
Start: 07/01/2011 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N545 Payment reduced based on status as an unsuccessful eprescriber per the Electronic Prescribing (eRx) Incentive Program.
Start: 07/01/2011
N546 Payment represents a previous reduction based on the Electronic Prescribing (eRx) Incentive Program.
Start: 07/01/2011
N547 A refund request (Frequency Type Code 8) was processed previously.
Start: 03/06/2012
N548 Alert: Patient's calendar year deductible has been met.
Start: 03/06/2012
N549 Alert: Patient's calendar year out-of-pocket maximum has been met.
Start: 03/06/2012
N550 Alert: 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 hold in the near future.
Start: 03/06/2012
N551 Payment adjusted based on the Ambulatory Surgical Center (ASC) Quality Reporting Program.
Start: 03/06/2012
N552 Payment adjusted to reverse a previous withhold/bonus amount.
Start: 03/06/2012
N553 Payment adjusted based on a Low Income Subsidy (LIS) retroactive coverage or status change.
Start: 03/06/2012 | Stop: 11/01/2012
N554 Missing/Incomplete/Invalid Family Planning Indicator.
Start: 07/01/2012 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N555 Missing medication list.
Start: 07/01/2012
N556 Incomplete/invalid medication list.
Start: 07/01/2012
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.
Start: 07/01/2012
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.
Start: 07/01/2012
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.
Start: 07/01/2012
N560 The pilot program requires an interim or final claim within 60 days of the Notice of Admission. A claim was not received.
Start: 11/01/2012
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 readmission.
Start: 11/01/2012
N562 The provider number of your incoming claim does not match the provider number on the processed Notice of Admission (NOA) for this bundled payment.
Start: 11/01/2012
N563 Alert: Missing required provider/supplier issuance of advance patient notice of non-coverage. The patient is not liable for payment for this service.
Start: 11/01/2012 | Last Modified: 11/01/2015
Notes: Related to M39 (Modified 11/1/2015)
N564 Patient did not meet the inclusion criteria for the demonstration project or pilot program.
Start: 11/01/2012
N565 Alert: 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.
Start: 11/01/2012 | Last Modified: 03/01/2013
Notes: (Modified 3/1/13)
N566 Alert: 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 to be processed.
Start: 11/01/2012
N567 Not covered when considered preventative.
Start: 03/01/2013
N568 Alert: Initial payment based on the Notice of Admission (NOA) under the Bundled Payment Model IV initiative.
Start: 03/01/2013
N569 Not covered when performed for the reported diagnosis.
Start: 03/01/2013
N570 Missing/incomplete/invalid credentialing data.
Start: 03/01/2013 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N571 Alert: Payment will be issued quarterly by another payer/contractor.
Start: 03/01/2013
N572 This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted.
Start: 03/01/2013 | Last Modified: 07/01/2014
N573 Alert: You have been overpaid and must refund the overpayment. The refund will be requested separately by another payer/contractor.
Start: 03/01/2013
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 accurate or contact the ordering/referring provider.
Start: 07/15/2013
N575 Mismatch between the submitted ordering/referring provider name and the ordering/referring provider name stored in our records.
Start: 07/15/2013
N576 Services not related to the specific incident/claim/accident/loss being reported.
Start: 07/15/2013
N577 Personal Injury Protection (PIP) Coverage.
Start: 07/15/2013
N578 Coverages do not apply to this loss.
Start: 07/15/2013
N579 Medical Payments Coverage (MPC).
Start: 07/15/2013
N580 Determination based on the provisions of the insurance policy.
Start: 07/15/2013
N581 Investigation of coverage eligibility is pending.
Start: 07/15/2013
N582 Benefits suspended pending the patient's cooperation.
Start: 07/15/2013
N583 Patient was not an occupant of our insured vehicle and therefore, is not an eligible injured person.
Start: 07/15/2013
N584 Not covered based on the insured's noncompliance with policy or statutory conditions.
Start: 07/15/2013
N585 Benefits are no longer available based on a final injury settlement.
Start: 07/15/2013
N586 The injured party does not qualify for benefits.
Start: 07/15/2013
N587 Policy benefits have been exhausted.
Start: 07/15/2013
N588 The patient has instructed that medical claims/bills are not to be paid.
Start: 07/15/2013
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 the use of a drug.
Start: 07/15/2013
N590 Missing independent medical exam detailing the cause of injuries sustained and medical necessity of services rendered.
Start: 07/15/2013
N591 Payment based on an Independent Medical Examination (IME) or Utilization Review (UR).
Start: 07/15/2013
N592 Adjusted because this is not the initial prescription or exceeds the amount allowed for the initial prescription.
Start: 07/15/2013
N593 Not covered based on failure to attend a scheduled Independent Medical Exam (IME).
Start: 07/15/2013
N594 Records reflect the injured party did not complete an Application for Benefits for this loss.
Start: 07/15/2013
N595 Records reflect the injured party did not complete an Assignment of Benefits for this loss.
Start: 07/15/2013
N596 Records reflect the injured party did not complete a Medical Authorization for this loss.
Start: 07/15/2013
N597 Adjusted based on a medical/dental provider's apportionment of care between related injuries and other unrelated medical/dental conditions/injuries.
Start: 07/15/2013 | Last Modified: 11/01/2013
N598 Health care policy coverage is primary.
Start: 07/15/2013
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 well as the Florida No-Fault Statute, which permits, when determining a reasonable charge for a service, an insurer to consider usual and customary charges and payments accepted by the provider, reimbursement levels in the community and various federal and state fee schedules applicable to automobile and other insurance coverages, and other information relevant to the reasonableness of the reimbursement for the service. The payment for this service is based upon 200% of the Participating Level of Medicare Part B fee schedule for the locale in which the services were rendered.
Start: 07/15/2013

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