N5Remark Code (RARC)Active
N5 Remark Code - EOB Received, Claim Not on File
The N5 remark code indicates that an Explanation of Benefits (EOB) was received from a previous payer, but the claim in question is not on file with the current payer. This suggests that the claim may not have been processed due to a lack of documentation or a prior claim submission issue.
How It Relates to the Denial
The N5 remark typically accompanies a Claim Adjustment Reason Code that indicates a denial or adjustment based on the claim not being found. The combination signals that the current payer has not received the necessary claim information from the previous payer to process this claim further.
Common Scenarios
1A provider submits a claim for a patient who has secondary insurance after a primary payer has processed the claim. The remittance from the secondary payer includes the N5 remark.
→ The N5 remark indicates that the secondary payer cannot find the claim in their records, even though they received an EOB from the primary payer. They expect the provider to ensure that the claim was correctly submitted to the primary payer.
2A facility bills a service to a patient who has switched insurance plans, and the remittance response from the new payer shows the N5 remark.
→ The N5 remark signifies that the new payer received an EOB from the previous insurance but cannot locate the claim in their system. This may require the provider to verify the claim’s submission history.
3A claim for a procedure is denied by a payer with the N5 remark after the provider initially submitted it to a different insurance company.
→ The N5 remark indicates that the current payer has received EOB information from the previous payer, but the claim itself is not on file. The provider may need to confirm the claim's status with the previous payer.
What to Do
- Confirm that the claim was submitted to the previous payer and check the submission status.
- Request a copy of the EOB from the previous payer to ensure it matches the current claim details.
- If necessary, resubmit the claim to the current payer with the required documentation from the previous payer.
What to Check
- The claim submission history to the previous payer.
- The EOB received from the previous payer for accuracy and completeness.
- The current payer's claim status to confirm if the claim is indeed not on file.