N117Remark Code (RARC)Active
N117 Remark Code - Lifetime Payment Limit
The N117 remark code indicates that the billed service has a lifetime limit, meaning it can only be paid once for a patient. This remark typically accompanies a claim adjustment where the service has been denied or reduced based on this lifetime payment policy.
How It Relates to the Denial
The N117 remark code usually appears with denial or reduction adjustments related to services that have a lifetime cap. It provides additional context to the accompanying claim adjustment reason code, clarifying that the service in question has already been utilized by the patient.
Common Scenarios
1A patient received a specific procedure that is typically only covered once, such as a particular surgical intervention. The claim was submitted for a repeat of this procedure.
→ The N117 remark signifies that the payer has determined the service has already been paid for this patient, and thus, no further payment will be issued.
2A patient was billed for a special medical device that is covered under a lifetime limit policy. The claim returned with a reduction in payment for the device.
→ Here, the N117 remark code explains that the device has been paid for once in the patient's lifetime, resulting in the claim adjustment reflecting this policy.
3A claim for a preventive service that can only be performed once is submitted for a patient who has already received it. The remittance shows a denial with a reason code.
→ The appearance of the N117 remark indicates that the service is subject to a lifetime limit, clarifying why the claim was denied.
What to Do
- Review the patient’s claim history to confirm if the service has been billed previously.
- Communicate to the patient that the service in question has a lifetime limit and cannot be billed again.
- Ensure future claims do not include this service for the patient to avoid further denials.
What to Check
- The patient's medical record to verify if the service was previously performed.
- The payer's policy documents regarding lifetime limits on specific services.
- The original claim submission to ensure proper coding and documentation were used.