N617Remark Code (RARC)Active
N617 Remark Code - Grace Period for Premium Tax Credit
N617 indicates that the enrollee is currently in the second or third month of a grace period for advance premium tax credits. This status can affect claims processing and payment due to the enrollee's eligibility for coverage during this period.
How It Relates to the Denial
The N617 remark typically accompanies a claim adjustment reason code that reflects a payment reduction or denial related to premium payment issues. The combination of the two codes signals that the payer is withholding payment based on the enrollee's grace period status.
Common Scenarios
1A provider submitted a claim for a patient’s office visit, but the payment was reduced due to premium payment issues.
→ The N617 remark suggests that the enrollee was in a grace period for their premium payment, which the payer is considering in their payment determination.
2An emergency service claim was submitted for a patient who has insurance through a marketplace plan, but the claim was denied with an accompanying adjustment reason code.
→ Receiving N617 means the enrollee's coverage is affected by being in a grace period, impacting the claim's payment.
3A claim for a routine procedure was submitted, and the remittance indicated a partial payment with a reason code for premium non-payment.
→ N617 clarifies that the patient is in a grace period for their advance premium tax credit, affecting the claim's final payment.
What to Do
- Review the claim adjustment reason code for more details on the payment reduction or denial.
- Consider contacting the enrollee to verify their premium payment status and inform them of their grace period.
What to Check
- The patient's insurance eligibility and premium payment history.
- The specific claim adjustment reason code that accompanies N617 for additional context.
- The enrollee's status in relation to their advance premium tax credit.