N607Remark Code (RARC)Active
N607 Remark Code - Service for Non-Compensable Conditions
The N607 remark code indicates that the service provided was for conditions that are not compensable under the terms of the patient's coverage. This means that the payer has determined that the specific condition being treated is not eligible for reimbursement.
How It Relates to the Denial
N607 typically accompanies a Claim Adjustment Reason Code that indicates a denial of payment based on the nature of the condition being treated. The combination suggests that the service rendered was related to a non-compensable condition as defined by the payer's policies.
Common Scenarios
1A provider submitted a claim for physical therapy services related to a chronic pain condition. The remittance advises that the claim was denied due to the nature of the condition.
→ In this case, N607 explains that the payer views the chronic pain condition as non-compensable, reinforcing the denial indicated by the accompanying reason code.
2A claim for a surgical procedure was submitted for a patient diagnosed with a cosmetic condition. The payment was denied, and the remittance included the N607 remark code.
→ Here, the N607 remark clarifies that the payer considers the cosmetic nature of the condition as non-compensable, aligning with the reason code that denied the claim.
3A claim for mental health services was denied because the diagnosis did not meet coverage criteria, with N607 included on the remittance advice.
→ The N607 remark indicates that the patient's mental health condition is classified as non-compensable by the payer, providing additional context to the denial.
What to Do
- Review the accompanying Claim Adjustment Reason Code for context on the denial.
- Consider whether the service provided can be justified under alternative coverage options, if available.
- If applicable, communicate with the patient regarding the non-compensable nature of their condition.
What to Check
- The patient's insurance policy for coverage specifics on the condition treated.
- Documentation of the medical necessity for the service provided.
- The claim submission details to ensure the correct condition was billed.