N643Remark Code (RARC)Active
N643 Remark Code - Not Covered Services Explanation
The N643 remark code indicates that the services billed are deemed Not Covered or Non-Covered according to the applicable state fee schedule. This means the payer has determined that the specific services provided do not meet the criteria for reimbursement as outlined in their fee schedule.
How It Relates to the Denial
The N643 remark code typically accompanies a Claim Adjustment Reason Code that also indicates a denial due to non-coverage. Together, these codes signal that the billed services are not eligible for reimbursement based on existing coverage guidelines.
Common Scenarios
1A provider submitted a claim for a specific procedure that is part of the state fee schedule but was denied.
→ The N643 remark code is pointing out that this particular procedure is not covered under the state's fee schedule, confirming the denial indicated by the accompanying reason code.
2A facility billed for a service performed on a patient, but the remittance shows an adjustment for non-coverage with the N643 remark code attached.
→ This indicates that the payer has reviewed the state fee schedule and determined that the service rendered is not covered, which is reflected in the denial.
3A claim for a therapy service was submitted, and the remittance returned with a denial and the N643 remark code.
→ The N643 remark code clarifies that the therapy service is considered non-covered based on the applicable state fee schedule, reinforcing the denial reason.
What to Do
- Review the accompanying Claim Adjustment Reason Code for additional details on the adjustment.
- Verify whether the service provided is included in the state fee schedule for coverage eligibility.
- Consider discussing the non-coverage with the provider to determine if alternative billing options exist.
What to Check
- The state fee schedule to confirm the coverage status of the billed services.
- The patient's insurance policy for any specific exclusions related to the services.
- The claim submission details to ensure that the correct procedure codes were used.