N406Remark Code (RARC)Active
N406 Remark Code - Coverage Conditional on Other Insurers
The N406 remark code indicates that the billed service is only covered when the recipient's other insurer(s) do not provide coverage for that service. This remark supplements an existing adjustment reason code, clarifying that coverage is contingent upon the absence of coverage from other insurers.
How It Relates to the Denial
The N406 remark typically accompanies adjustment reason codes that signal a denial based on coordination of benefits. It indicates that the payer expects verification of coverage status from other insurers before approving payment for the service in question.
Common Scenarios
1A patient received a specific therapy service and the claim was billed to the primary insurer. The remittance advice returned with a denial for the service, along with a reason code for coordination of benefits.
→ The N406 remark is indicating that payment for this therapy service will only be made if the patient has no other insurance that covers it. The payer is likely expecting confirmation that other insurers were checked.
2A surgical procedure was performed on a patient with multiple insurance plans. The claim was submitted, but the remittance showed a denial due to lack of primary coverage.
→ In this scenario, the N406 remark suggests that the surgical procedure is only eligible for reimbursement if the patient's other insurers do not cover it. The biller must verify the patient's insurance situation.
3A diagnostic test was billed after a patient was seen in the emergency room. The remittance returned indicating a denial with a reason code related to other insurance.
→ The N406 remark clarifies that the diagnostic test will be covered only if no other insurance is responsible for payment. This points to the need for the biller to check the patient's insurance coverage history.
What to Do
- Verify the patient's insurance coverage status with other payers.
- Submit documentation proving lack of coverage from other insurers if applicable.
- Check the adjustment reason code related to this remark for further details on the denial.
What to Check
- The patient's insurance eligibility and coverage documents.
- The claim adjustment reason code that accompanies the N406 remark.
- Any notes or comments from the payer regarding the coordination of benefits.