N189Remark Code (RARC)ActiveInformational Alert
N189 Remark Code: One-time Exception Payment Alert
The N189 code indicates that the service provided has been compensated as a unique exception to the usual limitations set by the plan's benefits. This alert serves as a notification rather than a reason for any denial or adjustment, highlighting that the payment is outside standard policy parameters.
What This Alert Tells You
As an informational alert, N189 does not accompany any adjustment or denial reason codes. It simply informs the provider that a one-time exception has been made regarding benefit restrictions for the billed service.
Common Scenarios
1A provider submitted a claim for a surgical procedure that typically has restrictions under the plan's coverage guidelines. The payment received included the N189 remark code.
→ In this case, the N189 alert informs the provider that the payment was made as an exception, signaling that the typical coverage rules were overridden for this instance.
2A claim for a high-cost imaging study was processed, and the remittance advice included the N189 code. This imaging service is generally limited under the plan's benefits.
→ Here, the N189 alert indicates that the payer has decided to pay for this imaging service as a one-time exception, which may not be available for future claims.
3A provider billed for a specialty drug that usually requires prior authorization, and the remittance advice returned with the N189 alert code.
→ The N189 code in this scenario signifies that the payer has authorized payment for this particular drug as a one-time exception, bypassing the standard prior authorization requirement.
What to Do
- Do not take any corrective action on this alert as it does not indicate a denial or adjustment that requires response.
- Continue to monitor future claims for similar exceptions, as this alert may not apply to subsequent submissions.
What to Check
- Review the original claim details to confirm the service billed and the payment received.
- Check the plan's benefit document for guidelines on the specific service to understand usual restrictions.
- Verify any prior communications from the payer regarding exceptions or special approvals for services.