N246Remark Code (RARC)Active
N246 Remark Code - Patient Payment Limitations Explained
The N246 remark code indicates that state regulations impose limitations on patient payment for the service billed. This means that the payment received may not reflect the full amount due to these patient payment restrictions.
How It Relates to the Denial
The N246 remark code typically accompanies an adjustment reason code that pertains to payment reductions based on state regulations. The combination signals that the payment adjustment is not only due to the claim review but also influenced by specific state laws regarding patient payment responsibilities.
Common Scenarios
1A provider submits a claim for a surgical procedure and receives a payment that is lower than expected, along with a reason code indicating a payment adjustment.
→ The appearance of the N246 remark code suggests that the reduction was influenced by state-mandated limitations on what the patient is required to pay for that service.
2A claim for a physical therapy session is processed, and the remittance statement shows an adjustment with a reason code, alongside the N246 remark code.
→ In this case, the N246 remark code indicates that the adjustment is due to state regulations on patient payment amounts, clarifying the reason for the payment reduction.
3A hospital submits a claim for outpatient services, and the remittance advice includes a reason code for a payment adjustment along with the N246 remark code.
→ The N246 remark code in this scenario points to state regulations affecting the patient's financial responsibility, explaining why the payment is less than billed.
What to Do
- Review the state regulations that apply to the service in question to understand the payment limitations.
- Confirm that the billed amount is compliant with the state payment guidelines before resubmitting any claims.
- If necessary, adjust the patient's bill according to state-mandated limitations.
What to Check
- The state-specific payment guidelines or regulations relevant to the service billed.
- The claim adjustment reason code that accompanies the N246 remark for further context on the payment adjustment.
- Any applicable patient payment contracts or agreements that may reflect state limitations.