N167Remark Code (RARC)Active
N167 Remark Code - Charges Exceed Post-Transplant Limit
The N167 remark code indicates that the billed charges exceed the coverage limit set for post-transplant services. This means that the payer has determined a maximum allowable amount for these services and the charges submitted surpass that limit.
How It Relates to the Denial
The N167 remark code typically accompanies adjustment reason codes that denote a denial or partial payment related to post-transplant care. The combination signals that while the claim was processed, the billed amount was not fully covered due to policy limits.
Common Scenarios
1A provider submitted a claim for follow-up care after a kidney transplant, billing for $20,000 in services.
→ The N167 remark code appears indicating that the billed amount exceeds the allowed limit for post-transplant coverage, suggesting the payer will not reimburse the full billed amount.
2A hospital billed for a series of rehabilitation sessions after a heart transplant, totaling $15,000.
→ With the N167 remark code, the payer is informing the provider that the charges submitted are above the established post-transplant coverage limit, which may lead to a reduced payment.
3A patient received multiple follow-up visits after a lung transplant, and the claim for $10,000 was submitted.
→ The appearance of the N167 remark code signals that the payer has determined the total charges exceed the allowable limit for post-transplant services, necessitating a review of coverage specifics.
What to Do
- Review the claim to confirm the billed charges and compare them against the payer's post-transplant coverage limits.
- Consider adjusting the claim to reflect the allowable amount or seek further clarification from the payer about the coverage limits.
What to Check
- The payer's policy document outlining post-transplant coverage limits.
- The claim details, particularly the services billed and their total charges.
- Any prior authorizations or coverage determinations related to the transplant services.