N765Remark Code (RARC)Active
N765 Remark Code - Coinsurance Not Covered
The N765 remark code indicates that the payer does not cover coinsurance that has been assessed by a previous payer. This remark supplements an adjustment already described by a Claim Adjustment Reason Code, clarifying that any coinsurance liability from a prior payer is not the responsibility of the current payer.
How It Relates to the Denial
Typically, the N765 remark appears alongside adjustment reason codes that denote reductions related to coinsurance amounts. This combination signals that the current payer is not addressing amounts deemed payable by a previous insurer.
Common Scenarios
1A patient received services from a provider and the claim was submitted to a primary payer first, which assessed a coinsurance amount. Upon processing, the secondary payer's remittance shows the N765 remark.
→ In this case, the N765 remark indicates that the secondary payer will not cover the coinsurance amount that the primary payer assessed, which is why it was not included in the payment.
2A hospital bills for a patient's surgery, and the primary insurance pays a portion but leaves a coinsurance amount. When the claim is sent to the secondary insurance, the remittance returns with the N765 remark.
→ Here, the N765 remark clarifies that the secondary insurance is not responsible for the coinsurance amount assigned by the primary insurance, thereby confirming the adjustment.
3A specialist submits a claim for a procedure that was partially paid by a previous insurer, resulting in a coinsurance charge. The secondary payer's remittance includes an adjustment reason code for the coinsurance and the N765 remark.
→ The N765 remark reinforces the adjustment reason code by stating that the secondary payer will not cover the coinsurance assessed by the first payer, leaving the patient responsible for that amount.
What to Do
- Review the adjustment reason code to understand the specific adjustment made by the payer.
- Communicate with the patient regarding their liability for the coinsurance amount, as it is not covered by the current payer.
- Ensure that the billing reflects the correct amounts owed by the patient after considering the previous payer's determination.
What to Check
- The remittance advice for the adjustment reason code that accompanies the N765 remark.
- The coinsurance amounts listed on the primary payer's explanation of benefits for accuracy.
- The patient's coverage details to confirm the sequence of payer responsibilities.