N199Remark Code (RARC)Active
N199 Remark Code - Additional Payment Approved
The N199 remark code indicates that an additional payment or recoupment has been approved following a payer-initiated review or audit. This code supplements the information provided by the associated Claim Adjustment Reason Code, clarifying that the payer has conducted a review and made a decision regarding the payment adjustment.
How It Relates to the Denial
N199 typically accompanies adjustment reason codes that relate to payment changes following audits or reviews. This combination signals that the payer has taken further action on the claim after their review process.
Common Scenarios
1A claim for a surgical procedure was initially denied for insufficient documentation, but after a review, the payer decided to approve an additional payment based on the submitted records.
→ The N199 remark code indicates that the payer has performed a review and approved additional payment based on the findings, suggesting that the initial denial was overturned.
2A hospital stay claim was partially paid, and the remittance shows a reason code for a payment adjustment due to a billing audit. The N199 code appears, indicating further payment is being issued.
→ Here, the N199 remark informs the billing office that the payer has completed their audit and is now providing additional payment as a result of their review.
3A claim for physical therapy services was reduced due to an audit, but the remittance indicates an N199 remark code alongside a reason for the reduction, suggesting additional payment has been approved.
→ The N199 remark signifies that despite the reduction, the payer has authorized additional payment following their review, which could mean adjustments were warranted.
What to Do
- Review the accompanying Claim Adjustment Reason Code for context on the initial adjustment.
- Ensure that any required documentation for the payer's review is properly attached and submitted if further action is needed.
- Confirm the details of the additional payment or recoupment in your billing system.
What to Check
- Check the remittance advice for the related Claim Adjustment Reason Code that the N199 supplements.
- Pull the payer's policy documents regarding review and audit processes to understand their criteria for additional payments.
- Verify the claim details against the payer's findings to ensure compliance with their review outcomes.