N559Remark Code (RARC)Active
N559 Remark Code - Service Area Not Payable
The N559 remark code indicates that the claim or service is not payable within the payer's designated service area. It specifies that the claim should be submitted to the payer or plan that covers the area where the ordering physician is located.
How It Relates to the Denial
N559 typically accompanies adjustment reason codes that indicate a service area issue or payment denial based on geographic restrictions. The combination signals that the claim was processed but cannot be paid due to the provider's location in relation to the patient or service area.
Common Scenarios
1A claim for a specialist consultation was submitted for a patient referred by a physician, but the remittance shows a denial related to service area restrictions.
→ The N559 remark suggests that the claim cannot be processed because the referring physician is outside the payer's service area, requiring resubmission to the correct payer.
2An outpatient procedure was billed for a patient whose primary care physician is located in a different state than the one where the service was provided.
→ The appearance of N559 indicates that the claim is not payable by the current payer due to the geographical mismatch, and it must be filed with the appropriate plan for the physician's service area.
3A claim for diagnostic tests was submitted, and the remittance included N559 along with an adjustment reason code indicating a denial.
→ This remark clarifies that the denial is due to the claim being outside the payer's service area, necessitating a resubmission to the payer associated with the ordering physician's location.
What to Do
- Verify the location of the ordering physician to confirm their service area.
- Resubmit the claim to the appropriate payer or plan based on the physician's location.
- Ensure that all claim details reflect the correct service area for processing.
What to Check
- The physician's service area documentation or network participation.
- The patient's insurance plan and coverage area.
- The claim submission details, including the ordering physician's address.