N68Remark Code (RARC)Active
N68 Remark Code - Payment Cancellation Due to Coverage
The N68 remark code indicates that a prior payment is being canceled because the patient was later found to be covered by a demonstration project at the site of service. This means that professional services were already compensated through a payment made to the facility, and the provider is required to refund any previous payments received for this claim.
How It Relates to the Denial
The N68 remark code typically accompanies a claim adjustment reason code that denotes the cancellation of payment due to a change in patient coverage. This combination indicates that the payer expects the provider to address the refund process as outlined in the accompanying reason code.
Common Scenarios
1A provider submitted a claim for services rendered to a patient and received payment. Later, the remittance advises that the payment is being canceled due to the patient’s eligibility under a demonstration project.
→ The N68 remark code informs the provider that the payment for the claim is being retracted because the patient was covered under a different payment arrangement. The provider must refund any prior payments related to this claim.
2After billing for a procedure performed at a facility, the provider receives an 835 remittance with an adjustment that cancels the previous payment, citing coverage under a demonstration project.
→ In this case, the N68 remark code indicates that the payment cancellation is due to the facility already receiving payment for the professional services. The provider is instructed to issue a refund for any amounts received.
3A claim is denied due to prior payment cancellation, and the remittance includes the N68 remark code, prompting the provider to investigate further.
→ The N68 remark code signals that the claim payment is voided because the patient’s services were covered by another payer or project, necessitating a refund from the provider for any amounts already collected.
What to Do
- Contact the facility to confirm the payment details related to the demonstration project.
- Refund any prior payment received from the patient or another insurer for the affected claim within 30 days.
- Ensure that future claims reflect the correct coverage status based on the demonstration project.
What to Check
- The original claim submission details to verify the services billed.
- Payment records from the facility regarding the demonstration project's coverage.
- Documentation related to the patient's eligibility under the demonstration project.