N45Remark Code (RARC)Active
N45 Remark Code - Payment Based on Authorized Amount
The N45 remark code indicates that the payment made was based on an authorized amount. This means that the payer has adjusted the payment to align with the amount that was previously approved for the service provided.
How It Relates to the Denial
The N45 remark code typically accompanies a Claim Adjustment Reason Code that explains the adjustment made to the payment. Together, these codes clarify that the payment is in accordance with the agreed-upon amount, often found in contracts or prior authorizations.
Common Scenarios
1A claim for a surgical procedure is submitted, but the payment received is less than the billed amount. The remittance shows a Claim Adjustment Reason Code indicating a reduction due to contractual obligations.
→ The N45 remark code confirms that the reduced payment is based on an authorized amount, likely defined in the provider's contract with the payer.
2A physical therapy service is billed at a higher rate than what was authorized. The remittance shows a lower payment along with a Claim Adjustment Reason Code for payment based on the allowed amount.
→ The presence of the N45 remark code suggests that the payer adjusted the payment to reflect the authorized amount for that therapy service.
3A diagnostic test is performed and billed, but the payment received is significantly lower than expected. The remittance includes a Claim Adjustment Reason Code indicating payment based on plan limits.
→ The N45 remark code indicates that the payment aligns with the authorized amount set by the payer's policy, clarifying the reason for the lower payment.
What to Do
- Verify the authorized amount in the payer's contract or agreement for the service provided.
- Ensure that any adjustments made are correctly reflected in the billing records and match the authorized amount.
- If necessary, adjust future claims to align with the authorized amounts to prevent similar issues.
What to Check
- The claim adjustment reason code that accompanies the N45 remark code for additional context.
- The payer's contract or agreement to confirm the authorized amount for the service.
- Any prior authorizations or communications from the payer regarding the service billed.