N67Remark Code (RARC)Active
N67 Remark Code - Professional Services Not Separately Paid
The N67 remark code indicates that the professional provider services billed were not paid separately because they are included in a facility payment under a demonstration project. It directs the provider to apply for payment to the facility or to resubmit the claim under specific conditions related to the patient's demonstration project status.
How It Relates to the Denial
The N67 remark typically accompanies adjustment reason codes that indicate a payment denial or adjustment due to the inclusion of services in a bundled payment under a demonstration project. This combination signals that the provider needs to take further action regarding the facility payment process.
Common Scenarios
1A provider submits a claim for outpatient professional services rendered to a patient admitted to a demonstration project facility. The remittance shows an adjustment for non-payment of those services.
→ The N67 remark indicates that the services are included in the facility's payment under the demonstration project, and the provider should seek payment from the facility rather than expecting payment from the payer.
2A claim is submitted for services performed on the same date as a patient's discharge from a demonstration facility, but the services were provided at a non-demonstration site. The claim is denied with the N67 remark.
→ The remark suggests that the provider must resubmit the claim with the provider ID for the non-demonstration facility, as the services are not covered under the demonstration project.
3A biller receives a remittance for a claim where the patient was treated at a demonstration facility, but the provider was not informed that the patient was excluded from the demonstration project. The N67 remark appears on the remittance.
→ This indicates that the provider should resubmit the claim if they have confirmation that the patient was excluded from the demonstration, as the initial claim was denied due to the bundled payment.
What to Do
- Apply to the facility for payment if the services are included in their payment under the demonstration project.
- Resubmit the claim with the provider ID number for the non-demonstration facility if services were provided outside the demonstration on the same date as admission or discharge.
- Ensure to verify if the patient was excluded from the demonstration before resubmitting the claim.
What to Check
- The facility's payment policy or demonstration project guidelines to understand payment inclusion.
- Patient records to confirm the location and timing of services in relation to the demonstration facility.
- Any notifications received from the facility regarding the patient's status in the demonstration project.