N658Remark Code (RARC)Active
N658 Remark Code - Non-Medical Expense Explanation
The N658 remark code indicates that the billed service(s) are not considered medical expenses by the payer. This suggests that the adjustment referenced by the accompanying reason code is based on the payer's determination that the service does not meet the criteria for coverage as a medical expense.
How It Relates to the Denial
The N658 remark code typically accompanies adjustment reason codes that indicate a denial based on the service not being eligible for payment. This combination signals to the biller that the services rendered were viewed as non-medical in nature, impacting the overall claim payment.
Common Scenarios
1A claim was submitted for a wellness program service provided to a patient, but the payment remittance shows an adjustment for the service being non-covered.
→ In this case, the N658 remark code clarifies that the wellness service billed is not recognized as a medical expense, supporting the adjustment made for non-payment.
2A provider billed for a cosmetic procedure, and the remittance returned an adjustment indicating the service is not covered by the plan.
→ Here, the N658 remark code reinforces that the cosmetic procedure is deemed non-medical by the payer, aligning with the associated reason code for denial.
3A claim for a fitness assessment was submitted, but the payer denied payment, citing a reason code for non-coverage, with N658 included in the remittance advice.
→ The N658 remark code indicates that the fitness assessment is not classified as a medical expense, providing context for the denial associated with the reason code.
What to Do
- Review the service billed to confirm its classification as a medical expense.
- Consider resubmitting the claim with additional documentation if the service should be covered under the plan's benefits.
- Communicate with the patient regarding their financial responsibility for the non-covered services.
What to Check
- The plan benefit document to verify coverage for the billed service.
- The eligibility response to confirm the patient's benefits regarding the service in question.
- Any clinical documentation that supports the medical necessity of the billed service.