N172Remark Code (RARC)Active
N172 Remark Code - Patient Not Liable for Charges
The N172 remark code indicates that the patient is not responsible for the denied or adjusted charges associated with the updated service or item. This means that the claim has been adjusted based on specific circumstances related to the patient's liability for the service provided.
How It Relates to the Denial
The N172 remark code typically accompanies reason codes that indicate a denial or adjustment due to the patient's non-liability for the charge. This combination signals that the payer has determined the charges should not be the patient's financial responsibility.
Common Scenarios
1A claim for a follow-up visit was denied with a reason code indicating the service was not covered. The remittance included the N172 remark code.
→ In this case, the N172 remark clarifies that the patient does not owe anything for the denied visit because the service is not covered under their plan.
2A claim for physical therapy services was adjusted with a reason code indicating that the services were deemed unnecessary. The remittance shows the N172 remark code.
→ Here, the N172 remark suggests that despite the adjustment, the patient is not liable for the charges related to the therapy sessions.
3A bill for a surgical procedure was partially denied, and the remittance included a reason code related to pre-authorization. The N172 remark appeared on the remittance advice.
→ This indicates that although the procedure was partially denied, the patient will not be held responsible for the denied charges due to the circumstances of the service.
What to Do
- Review the claim adjustment reason code to understand the basis for the adjustment or denial.
- Confirm that the patient is not liable for the charges as indicated by the N172 remark code.
- Communicate with the patient about their lack of financial responsibility for the adjusted services.
What to Check
- The claim adjustment reason code associated with the N172 remark.
- Documentation related to the service/item provided to the patient.
- The patient's benefit plan details to confirm coverage and liability.