N726Remark Code (RARC)Active
N726 Remark Code: Conditional Payment Not Allowed
The N726 remark code indicates that a conditional payment is not permitted. This suggests that the payer has determined that the circumstances surrounding the claim do not meet their criteria for a conditional payment, which typically occurs when certain conditions must be fulfilled before payment is made.
How It Relates to the Denial
The N726 remark code typically accompanies a Claim Adjustment Reason Code that indicates a denial or adjustment due to the conditional nature of the payment. The combination signals that the payer has reviewed the claim but found it does not qualify for conditional payment under their policies.
Common Scenarios
1A claim for a surgical procedure was submitted with a note indicating it was contingent upon a pre-authorization that was not obtained. The remittance shows the claim was denied.
→ The N726 remark code clarifies that the payer will not allow any conditional payment because the necessary pre-authorization was not in place, reinforcing the initial denial indicated by the accompanying reason code.
2A provider billed for a diagnostic test that was contingent on the results of a prior test. The payer denied the claim due to the lack of the initial test results.
→ The presence of the N726 remark code indicates that the payer is firm in their stance that conditional payments are not permissible in this case, aligning with the reason code that reflects the denial.
3A physical therapy claim was submitted with an anticipated outcome that was not met. The payer denied the claim stating that additional documentation was needed for conditional payment.
→ Here, the N726 remark code reinforces that the payer does not allow conditional payments without the required documentation, and this aligns with the claim adjustment reason code provided.
What to Do
- Review the accompanying Claim Adjustment Reason Code for specific details on the denial or adjustment.
- Ensure that any conditions required for payment have been addressed if resubmitting the claim.
- If applicable, obtain the necessary documentation or authorizations that the payer requires for conditional payments.
What to Check
- The Claim Adjustment Reason Code on the remittance advice to understand the basis of the denial.
- Any pre-authorization records related to the claim to verify compliance with payer requirements.
- Documentation submitted with the claim to ensure all necessary information was provided.