N160Remark Code (RARC)Active
N160 Remark Code: Patient Choice Required for Payment
The N160 remark code indicates that the patient needs to select an option before payment can be processed for the billed procedure, equipment, supply, or service. This code typically accompanies a claim adjustment reason code that reflects a denial or delay in payment due to the patient's choice being required. It signals to the biller that a decision from the patient is necessary before proceeding with payment.
How It Relates to the Denial
The N160 remark code usually appears alongside claim adjustment reason codes that involve denials or pending status related to patient consent or selection. This combination indicates that the claim cannot be processed until the patient provides the needed choice or option regarding the service or supply.
Common Scenarios
1A patient received a durable medical equipment (DME) item but the claim returned with a denial stating that the patient must select a rental or purchase option first.
→ In this case, the N160 remark code is clarifying that the claim cannot be paid until the patient specifies whether they want to rent or purchase the equipment.
2A claim for a procedure was submitted, but the remittance advised that payment is on hold because the patient did not choose between two different treatment options.
→ Here, the N160 remark code indicates that the payer requires the patient's decision on the treatment option before they will authorize payment.
3A supply claim was submitted for approval, but the remittance includes the N160 remark, indicating the patient needs to confirm which brand of the supply they prefer.
→ The remark is pointing out that without the patient's choice of the brand, the claim cannot be processed for payment.
What to Do
- Contact the patient to determine their choice or option regarding the billed service or item.
- Document the patient's decision and ensure it is communicated to the payer as needed.
- Do not resubmit the claim until the patient has made their selection.
What to Check
- Claim adjustment reason code on the remittance advice for context on the denial or delay.
- Patient records to verify if they have been informed of the choices available.
- Any communication with the patient regarding their preferences or decisions on the service or supply.